Hello and welcome back everyone. I have an amazing guest with me today who I can’t wait to learn more about the way he approaches endometriosis. So first I want to welcome Dr. Adam Duke to the podcast today. Welcome.

Adam (00:19)

Thank you.

Thank you very much for having me. I’m very excited to be here.

Ginger Garner PT, DPT (00:23)

Yeah, thanks for, first of all, I just have to say this before I tell everybody how awesome you are and read your bio and all that stuff that I usually do. I just want to say that, you guys, we were just talking before I hit press record about not just the amazing work that he’s doing, but the fact that he’s working really hard. So I just want to thank you for taking the time today on your…

you know, at a time you have free time after all the cases that you did, because I saw your post, was it on Instagram, I think, where you did 70 cases in December. I mean, holy cow. So, yeah.

Adam (00:56)

Yeah, yeah, on Instagram.

a lot. It’s a lot.

not all endo but probably 85 % endo cases. Yeah, so

Ginger Garner PT, DPT (01:09)

Yeah,

which is a good segue into your bio. Let me tell you guys a little bit about Dr. Adam Duke. He graduated from Creighton University School of Medicine, performed his OB-GYN residency at Eastern Virginia Medical School, and completed a two-year minimally invasive GYN surgery fellowship at the University of Tennessee, not far away from me. He was the first fellowship trained MIG surgeon in the state of Idaho, did not know that. Wow. Okay, all right.

Adam (01:12)

Yeah.

Yeah, there’s still only

two of us, me and my partner. Yeah.

Ginger Garner PT, DPT (01:40)

my gosh, yeah,

and we could definitely get into details about that. I’m in North Carolina and we have our own challenges here as well. So Idaho is lucky to have you. Dr. Duke is a nationally recognized endometriosis expert and a surgeon who lectures across the country. His other clinical expertise is chronic pelvic pain and the surgical treatment of prolapse and incontinence, which often goes together with endometriosis.

especially from my viewpoint, vantage point, in pelvic fatigue. So, see a lot of that. During his seven years at Northwest Women’s Care, Dr. Duke has seen patients from across the country and around the world seeking his medical expertise. Welcome. Yeah. All right, the first question I have for you has absolutely nothing to do about your surgical expertise whatsoever.

Adam (02:25)

Yeah, thank you. Yeah, very excited to be here.

Good.

Ginger Garner PT, DPT (02:36)

Okay, how did you land on EndoBro for your Instagram handle?

Adam (02:40)

so the endo bro, it started kind of as a joke. a couple of years, I’ve been going to the endo summit for a number of years now that Sally and Andrea put on. And, a couple of years ago, somebody said to me, what did they say? They were like, you’re like a frat guy who became an endometriosis expert. And the irony is that I was, I was never, I’ve never been in a fraternity in my entire life. I was never in a frat. I just didn’t like that kind of scene. And,

Ginger Garner PT, DPT (03:08)

Yeah.

Adam (03:09)

But they said, you’re like a frat guy who became an endometriosis specialist. then someone else, it was actually Jordan Hutchison, think, he was like, you’re like the endo bro. And so I kind of did it. I kind of did that handle as a joke. I wasn’t really, I just don’t have a lot of time. I actually don’t have a lot of time for social media stuff. so I kind of did it as a joke and not thinking that anybody would really see it. And then it just kind of took off and everybody.

Ginger Garner PT, DPT (03:36)

and then it’s

stuck.

Adam (03:37)

everybody thinks it’s hilarious and now I’m stuck with it.

Ginger Garner PT, DPT (03:41)

It did, because I remember looking different people up and then landing on your profile last year, probably during Endo Summit, as a result. so I’ve been curious about that since then.

Adam (03:47)

Yeah.

Yeah,

it was sort of an ironic joke that stuck. So, yeah.

Ginger Garner PT, DPT (03:59)

Yeah,

that must like somehow with like the sense of humor and which is I think important when dealing with all the heavy things that you you have to deal with. How does that influence like your approach to patient care when you’re going in and you have to have all these hard conversations all the time? You know people say laughter is medicine. So how does that end up like finding its way into your patient care?

Adam (04:05)

Yeah.

Yeah.

I think there is a lot of humor. One thing I’ve always been pretty good at and the reason why my mom thought I should have been a lawyer and not a doctor is that I’m generally pretty good at reading people and reading faces and reading sort of what patients are looking for and whether that’s a serious conversation or whether they want lighthearted. I’ve always been pretty good at reading the room and picking up on that.

And so I do use a lot of humor. There’s a lot of laughter in rooms. And I think when you’re having those serious conversations about fertility and need potential for future surgery, think keeping it light is helpful. But I’m also, I’m very matter of fact, and I have a reputation for just sort of saying it like it is.

That can be good and bad. I some patients like that, some patients don’t. But the vast majority of patients, by the time they come to see me, they’ve had five, six, seven surgeries before. me sort of sugarcoating things or beating around the bush, I think is not helpful in any way. This is how it is, this is how it’s gonna be.

Ginger Garner PT, DPT (05:45)

Mm-hmm.

Adam (05:50)

Patient input, of course, I mean, I never tell patients like, this is what you have to do or this is what you have to do. I sort of present these various options for how we can approach disease. And it’s almost like a choose your own adventure book. And I make that, I quote that a lot. I say that a lot to patients, know, these are all the options. What do you want to do? But yeah, I think being direct and, also using humor, I think are very important because this is a tough disease.

Ginger Garner PT, DPT (06:08)

Yeah.

Mm-hmm.

Adam (06:16)

It’s tough on surgeons. mean, it’s tough on patients. It’s tough on the physical therapists. It’s just a tough disease.

Ginger Garner PT, DPT (06:22)

Mm-hmm. Yeah, it

is. I think that’s…

It’s one of the softer sides of care, of providing care to women and people with endometriosis that can be really easily undervalued and go, that’s not important. Let’s just talk about how great he is at excision surgery. I think you’re right. One thing you pointed out, which is by the time they get to you, they want to just hear the straight talk to just…

Tell me what the options are, tell me what I need to do, tell me what I can do to finally have some relief from this. I noticed one of the other things on your Instagram, was it like a crossword puzzle or something like that for Endo? was something like that, something creative. You’re doing something like, you know.

Adam (07:03)

Yeah.

not on mine. think I do a lot of like I use it. mean, a lot of my posts are just kind of funny. mean, that’s like, because I think, you know, there’s there’s so many endo accounts out there. They’re just like, look at how awesome of a surgeon I am. It’s not really my thing. I you know, I mean, I do I do post some surgical videos on there and stuff, but and some pictures of but I usually kind of do it in a in a way that’s humorous or, you know, makes patients chuckle or makes people chuckle. So

Ginger Garner PT, DPT (07:23)

Yeah.

Yeah.

Adam (07:46)

That’s kind of been my approach to it. I sometimes joke, I’m not the greatest endometriosis surgeon that ever walked the earth or anything, far from it. And I do have patients that I sometimes get in and I say, I can’t do this. And there have been patients that I’ve sent to Fogelson or Bossbrocker.

two surgeons who I respect a lot and they’re relatively nearby or Shanti even now that she’s with Nick. And, you know, I think where my strength lies, you know, am I a pretty darn good endosurgeon? Yeah, I am. But I think where my strength lies is in almost more, I consider myself an advocate, I think, first and foremost, maybe even more than a surgeon. And I think

What patients see in me or when they come to me is that I believe them. I believe what they have to tell me. And that I think that’s powerful medicine. When patients are sitting in my office and they’re telling me this litany of symptoms, I believe them. say, yeah, that’s all reasonable. That all sounds like endometriosis. I don’t say, there’s no way that can be endometriosis.

And crazy stuff. Like I’ve had a, I had a patient about a year ago who had this unexplained restrictive lung disease. She’d had, she was on, she was like 36 years old, terrible endometriosis. But she was on, happened to walk around with an oxygen can. Her sats on room air were like 80%, 78%. I she was in rough shape.

Ginger Garner PT, DPT (09:35)

Hmm.

Adam (09:40)

She’d been to every specialist in Seattle, every pulmonologist, they’d done biopsies, they’d done all sorts of bronchoscopies. Nobody could figure this out. So we went in with the idea that it was probably, she was like, is this my endometriosis? And everybody told her, no, it can’t possibly be endometriosis. And I said, well, maybe. Maybe there’s diaphragmatic disease. And we went in expecting to find diaphragmatic disease, and there actually wasn’t diaphragmatic disease. But just in resecting all of the endometriosis from her pelvis,

Ginger Garner PT, DPT (09:57)

Mm-hmm.

Mm-hmm.

Adam (10:09)

Within two weeks, she was off her oxygen. And I have no explanation for that. I have no rational explanation for that. And nobody does. pulmonologists were astounded by this. They’re like, wait, what? She’s off her mirror without any diaphragmatic disease. And she’s fine. She’s still, I mean, I just saw her in follow-up not that long ago, and she’s great. And so I think that was the most powerful medicine was the combination of excision, but also just listening to her and…

Ginger Garner PT, DPT (10:12)

Mmm.

Mm-hmm.

Adam (10:37)

and believing that somehow this endometriosis because of the systemic inflammatory effect could have caused her restrictive airway disease. And it’s just bizarre, but it happened.

Ginger Garner PT, DPT (10:49)

Right. It’s

incredible. I actually will be talking about the voice to pelvic floor connection at this year’s Endo Summit and doing a lab on that. And so when you told me that story, of course, my eyes are like, yes, you know, because of the common restrictions that I’ll see when I’m using imaging, ultrasound imaging in practice.

Adam (11:07)

Yeah.

Ginger Garner PT, DPT (11:18)

to image the respiratory diaphragm and other things, the lateral dominal wall, et cetera, and then see those connections and see how restricted their breathing is on a regular basis and see how much that can change, of course, after well-done excision surgery too, along with adhesions and other things that it can spawn. But that’s an incredible story. Thank you for sharing that, because that to me is powerful.

And also that just another indication of how much the respiratory diaphragm and the pelvic cavity, pelvic floor, and the pelvic diaphragm are just interdependent.

Adam (11:59)

Oh yeah, absolutely. mean, the shortness of breathing is a very common complaint and it doesn’t always mean diaphragmatic endo or thoracic endo. I mean, that’s certainly a thing, I mean, most of the time, most patients improve. It’s a combination of excision and pelvic floor PT. really is what, that’s the winning combo. We send, my partner and I, Dr. Young, we send virtually 100 % of our patients

Ginger Garner PT, DPT (12:03)

Mm-hmm.

Yeah.

Adam (12:28)

to pelvic floor PT both before and after surgery. Because I think that’s incredibly important for those patients.

Ginger Garner PT, DPT (12:32)

Yeah.

Yeah,

from a logistical perspective too, there’s so much prep that can be done. And also another softer aspect is there could be so much fear around it. And because they’re probably experienced gas lighting, dismissal, you know, in other medical realms, being able to work through that and help them realize, you know, that we are going to be helping them and that they can…

Adam (12:40)

we need.

Ginger Garner PT, DPT (13:03)

kind of reestablish that trust with the medical establishment that they probably have lost over time. That’s huge. Well, it’s kind of like you were reading my thoughts because the next question that I was gonna ask you is exactly what we just talked about. So thank you very much. That’s a great segue. Because this is what I was gonna ask is what steps you’re taking to ensure patients feel informed, validated, empowered through their whole journey and.

Adam (13:09)

no doubt, yeah.

I told you I’m good at reading the room.

Ginger Garner PT, DPT (13:32)

I mean, I think that you answered that question really well, but I also wanted to reiterate that question to the listener because I think that’s one of the most important things that can be done when you are looking for someone to help you through the process with your journey of endometriosis. You should feel well-informed. You should feel validated and very empowered through the entire process.

Adam (13:54)

Yeah, I mean, I completely agree with that. you know, I don’t know that I’ve ever told a patient, that’s ridiculous, or that there’s no way that symptom is related to your endometriosis. I mean, weird stuff like patients have knee pain and elbow pain. I mean, I just think it has to do with this, you know, again, this sort of systemic inflammatory response.

Ginger Garner PT, DPT (14:21)

Mm-hmm.

Adam (14:22)

if you boil endometriosis down to what it is, it’s very inflammatory tissue. And this idea that endometriosis only causes pain in the pelvis is absurd to me.

Ginger Garner PT, DPT (14:37)

It is, and so

widely accepted as just a normal description of what endo is. And yeah, so thanks for bringing that up. That’s so important.

Adam (14:41)

Yeah.

Yeah, there’s just, yeah, there’s, mean, I think there’s been this sort of like dogmatic approach to endometriosis and I’m not gonna get myself in trouble by saying where that comes from, but we all know, you know, the various organizations that sort of dictate how endometriosis is approached. And there’s, you know, sort of this like hierarchical treatment where it’s, you know,

NSAIDs and then birth control and then it’s like this pyramid and then you get to the top and then it’s know, GR, know, the the GR GNRH, you know, agonist and antagonist and things like that. And, you know, this idea that like surgery only be used as a very, very last resort. You know, most patients I think are by the time patients come to me, they’re they’re wanting, you know, they’re wanting that.

Ginger Garner PT, DPT (15:16)

Mm-hmm.

Adam (15:43)

They’ve been through the rigmarole of all of these treatment options, or they’ve been through the full duration surgeries. so they’re motivated, most of them. Most patients, by the time they come to see me, it’s more validating what they’ve been through, validating their concerns. There’s not a huge amount of convincing patients.

you know, regards to surgery because they’re kind of ready for it. And I think, you know, where the pelvic floor physical therapists though are so helpful is, you know, patients are ready for surgery, but they might not fully understand, you know, what it entails and how recovery is going to go. And we try to do a lot of that counseling as much as we can. I mean, we are, you know, I’m seeing patients for 30 to 40 minutes at a time.

Ginger Garner PT, DPT (16:31)

Mm-hmm.

Adam (16:41)

you know, kind of as a pre-op or as a, as a, you know, a new patient visit, a pre-op, a post-op, like we’re not spending that as much of that time with them as, the pelvic floor physical therapists who are seeing them weekly for weeks on end, months on end. So that expectation of, you know, how surgery is going to go, how recovery is going to go, a lot of that is coming from you guys, you know, and I’ll be the first one to admit that.

Ginger Garner PT, DPT (17:07)

Yeah, yeah.

Well, it definitely takes a village and I try to get all of my patients to you guys ASAP because there are too many heartbreaking stories of them being misinformed, you know, by providers who, you know, may or may not be giving them the right information. you know, that intervention from you guys is just absolutely essential.

Adam (17:20)

Yeah.

Ginger Garner PT, DPT (17:36)

for them to get to the right place as soon as possible. To that end, speaking to those providers who maybe aren’t informed about Endo, I know you have heard and seen and experienced probably a range of stories we could talk for hours about, but I think that one of the most pragmatic practical things that I think come up is when they have been to…

OB-GYN or whomever that is, and that person says they do excision or that person says, you know, they do endosurgery and they’re just doing ablation. And let’s say they finally get to you or another expert excision surgeon. What happens when that patient goes back home and that provider doesn’t want to see them anymore? How do you navigate this process? Because that’s a huge

Well, I don’t want to label it ego problem, whatever we want to label it, but it still means they go home and they’re like, what now? They may have a great pelvic PT or whatever, but they still need to go back to and find a provider. What happens?

Adam (18:36)

Yeah. Yeah.

That’s a struggle. I that is something that we struggle with a lot. I don’t get, within my local community, mean, don’t get referrals from the OBGYN. There’s a couple of them that do. But I have been able to make relationships with providers in Missoula and Boise. But locally, we don’t get any referrals at all. So fortunately,

the local patients can still come and see us. The ones that travel, you know, I have been able to make some relationships with Missoula Boissy, but it’s tough. mean, it is a really hard, you know, like, or if we do a hysterectomy, for instance, on a patient, like who’s gonna check their vaginal cuff, you know, in eight to 10 weeks. And it is something we struggle with. And so I…

Ginger Garner PT, DPT (19:37)

Mm-hmm.

Mm-hmm.

Adam (19:46)

be honest, I don’t have a great answer for that because we do these surgeries and then we send the patients out and it’s like, we follow up via telephone, but if something comes up in the future, we just make it very clear that they can always call us. We might not 100 % be able to tell them over the phone what’s going on, but they can always reach out to us and we can order imaging.

Ginger Garner PT, DPT (19:48)

Yeah.

Yeah.

Mm-hmm.

Adam (20:14)

locally or whatever we need to do, you know, to kind of to figure it out. it is a problem. And I do wish that there was less of the well, you know, like you said, I mean, it’s it’s you know, it’s like, well, if I wasn’t good enough to do your surgery, why am I good enough now to, you know, do your cuff check or whatever, whatever it may be? And we do have a lot of that. We actually have a couple of groups in the region that

Ginger Garner PT, DPT (20:36)

Mm-hmm.

Adam (20:44)

have explicitly told their patients that if they come to see me or my partner for surgery, they will no longer care for them in any capacity. And that’s, mean, it’s so hard for patients because then they’re kind of feel a little bit, you know, stuck. We obviously don’t do any obstetrical care. And so then patients feel a little bit stuck. They’re like, well, it’s almost like,

Ginger Garner PT, DPT (20:51)

Wow.

Yeah.

Mm-hmm.

Adam (21:10)

then they’re afraid to leave their OB-GYN because they don’t have a way, you know, they’re gonna need annuals and possibly obstetric care and things that we don’t do. And it’s almost like they’re like trapped there because they’re afraid, yeah.

Ginger Garner PT, DPT (21:13)

Yeah.

Yeah.

Yeah, it’s a fear

mongering situation where they have made them afraid to leave. And this is such an important topic that I don’t think gets talked about enough. It’s almost as if, you’ve probably rolled things over like this in your mind and probably had the conversation a bunch, but I think that in terms of discussing it on a podcast, I don’t know that this is discussed that often, is…

Adam (21:30)

Right.

Ginger Garner PT, DPT (21:52)

what to do, actually do about that for the long term. What would that look like? Because I know we have Nancy’s Nook and how vetted that process is, but it’s almost like the fields of OB and GYN should be separate. Instead of heaping on the heads of all OB-GYNs, the clinical day-to-day care and the surgery and everything, mean, we have cardiothoracic surgeons and we have cardiologists.

Adam (21:58)

Yeah.

Ginger Garner PT, DPT (22:21)

Why is everything in the world heaped on top of ob-gyn’s that you’re just supposed to be the expert of everything?

Adam (22:28)

Right. And it’s impossible. mean, I’m thinking back to my residency training program, which was a pretty good residency in the grand scheme of things. But I mean, our GYN training was not great. And I mean, think I finished my residency with 70 lapists. And that was because I was being very aggressive. Like I was going on my days off when I was over my work hour duties.

and just scrubbing in cases because I just wanted to do as much surgery as possible. that and that even that was not that many. I graduated my from an obstetrical standpoint. I think I did something like 600 C sections in residency compared to 70 lapis. And like there was one of my co-residents and she finished with 20 lapis. And so to do only do 20 lapis under the tutelage of someone and then just be thrust out there completely on your own.

and know how to potentially manage complications or better yet avoid complications, it’s just not happening. I think with the duty hour restrictions and OB, GYN residents essentially being cheap labor for busy OB wards, we’re not getting that gynecologic training. my first year, so I finished my

residency, like I said, was 70 lapis. My first year of fellowship, I did over 500 lapis. So the difference in volume between, you know, fellowship and residency, was, you know, night and day. I mean, it was, it was absolutely night and day. And, and I think if you’re like, I was never really exposed to MIGS in my residency. We didn’t have a MIGS program. And so I didn’t know what these guys were doing. You know, I, I was, I was interested in

the surgery, I knew I didn’t want to do OB. Actually, after my intern year, I almost switched to general surgery, but they wouldn’t count my, I just, I knew that I wanted to do surgery and I was going to switch, but they wouldn’t count my intern year of OB as an intern year of gen surge. And so I would have had to like start over. And I was just like, I’ve already been through the hardest year. And so I just stuck, stuck with it kind of knowing that I wanted to go into a surgical subspecialty of OB-GYN.

Ginger Garner PT, DPT (24:30)

Wow.

Mm-mm.

Adam (24:53)

But I made the decision to be very aggressive about getting as many GYN surgeries as I could, and I still didn’t finish with that many. And I think the point that I was trying to make before I got sidetracked was that I think that ultimately is the answer is to separate OB and GYN. And that’s been a call of a lot of the leaders of AGL for a long time.

But if you’re not exposed to MIGs in residency, you don’t know what you don’t know. And I think that’s the really scary thing is that we’ve like let loose this generation of OB-GYN surgeons who have never been exposed to MIGs and really don’t know how to properly excise endometriosis or, you know, do these types of things that we’re doing. And I think because they’ve never seen it or never seen what we do,

Ginger Garner PT, DPT (25:27)

Yeah.

Adam (25:50)

they think that they can do all the things we can do. And that’s why when you look at their websites, it’s like, oh, they’re an expert in endometriosis. They’re an expert in this, that, and the other, but they’ve never actually like been in the OR with me. They don’t know what my partner and I do or what, you know, the Fogelsens and Sinervos and whoever do, know, they just don’t know what we’re doing because they’ve never been exposed to it and they’ve never seen it. So they come out of residency thinking, hey, my,

Ginger Garner PT, DPT (26:04)

Mm-hmm.

Mm-hmm.

Adam (26:19)

you know, 100 hysterectomies, I’m good, I’m set up. I know exactly what I’m doing. until there’s more exposure to MIGs or the two specialties are completely separated, I don’t think that’s going to change. So, but fortunately, I mean, the MIGs programs are becoming more commonplace. Like when I went through and was applying for fellowship, I think there were 24 programs in the whole country. And now there’s something like 50 or 60.

Ginger Garner PT, DPT (26:33)

Yeah, that’s it.

Adam (26:45)

So more as more and more academic residencies are getting mixed programs, they are being exposed to that. And I hope there’s that light that clicks and it’s like, what they’re doing is kind of crazy. You know, like, I mean, I do my own bowel stuff. do my own, you know, and like that’s, that’s kind of crazy. It’s probably not the standard of care for an OB GYN to be, you know,

Ginger Garner PT, DPT (26:58)

Yeah.

Adam (27:13)

fixing his own bowel, if I get into bowel, I fix it myself. Or if I have to do a discoid resection, or if I have to, whatever, if I resect bladder endometriosis, I don’t call it an urologist, I do it myself. And if you haven’t been exposed to that, you just don’t know what we’re doing.

Ginger Garner PT, DPT (27:26)

Mm-hmm.

Yeah. Yeah.

So obviously, you know, a problem that’s been, that’s eternal and has always existed that not necessarily is tabled, but is kind of an emerging topic that eventually something will have to shift and change because obviously the system as it’s working right now is fractured. But from the aspect of the patient, like when we talk about what a patient can do,

to then navigate the system as it is with its imperfections and the fractures that exist. What advice do you have? And one of the targets I think to talk about would be MIGS because to the listener, they may be then going, okay, tell me what MIGS is again. And then they may also have never heard of Nancy’s Nook. So that will be in our show notes, the link for that.

But when you’re talking about helping the patient navigate the process of identifying that skilled surgeon wherever they may be anywhere in the world and advocating for themselves, what suggestions do you have based on what we were just talking about with kind of the brokenness of the system?

Adam (28:48)

I mean, I think the best thing that patients can do is to continue to educate themselves. You know, we live in a world now where there is so much information. It’s not all factual information, obviously, but there is so much information out there now with regards to endometriosis. I mean, this is how I get

you know, 90 % of my patients is word of mouth slash Nancy’s nook slash, you know, the internet, very few direct referrals. but that’s, and that’s what I can’t quite, like I have patients who come to me and they’ve had three or four full duration surgeries and they had asked their OBGYN, this is locally, you know, Hey, this isn’t working. I need to see a specialist. And they’ve been told there’s no such thing as specialists. There’s no such thing as endometriosis specialist. We just have to keep doing.

the glupron and the fulguration surgeries, there’s no, like they literally go to that trouble to tell, and then patients find us inevitably. They find us because of this magical thing called the internet. It’s been around a while. Everybody knows about it, you know? And then the patients are angry. They’re so angry that they were lied to, that they were told that this was not an option, that there was no such thing as a specialist, or that…

Ginger Garner PT, DPT (29:57)

You

Yeah. Yeah.

Adam (30:10)

what I do, that they can do everything that I can do. And I’m not trying to sound arrogant. I know there’s things that I can’t do and I send those patients off because that’s the right thing to do. But to tell a patient that there is nobody out there that’s a specialist, everything they can do, I can do. I have the same training that they have is absolutely horrific to me. And I don’t understand it. And then patients, by the time they come and see us, they are angry. They are very angry.

Ginger Garner PT, DPT (30:32)

Mm-hmm.

Adam (30:39)

And I say, channel that anger into empowerment, educating yourself as much as you can about this disease and educate others. And I’ve had, and this is the advocacy part of me where I sometimes think I’m more of an advocate than a surgeon is that so many of my patients have gone on to start blogs and do podcasts and host.

Ginger Garner PT, DPT (31:01)

.

Adam (31:06)

I had a patient host an endometriosis awareness event at the Spokane Library. Like she just took a bunch of information in the library during endo awareness month and there were like 60 people there, you know, so things like that. And I think that my patients, they feel my advocacy, they feel my anger, they feel my frustration and they run with it. And I love that. I absolutely love that because they’re doing the work that, you know, that I’m doing.

Ginger Garner PT, DPT (31:17)

Yeah.

Yeah.

Adam (31:35)

just not the surgical aspect of it obviously, it, know, patients are, they’re not stupid and treating people like they cannot make decisions for themselves is absolutely not how you practice medicine. Like I get emotional talking about it because it’s just, you see these people who’ve just been through so much, you know, and

Ginger Garner PT, DPT (31:55)

Mm-hmm.

Adam (32:04)

than to lie to them and tell them that there’s nobody who can fix you is, it makes me so angry. But patients all, they talk. And the word of mouth and the endometriosis community is, it’s strong. I mean, it’s vocal and it’s militant and it’s angry. And I love it. I love it. I love hearing.

Ginger Garner PT, DPT (32:12)

Yeah.

Yeah.

Adam (32:31)

I know that that anger and that frustration comes from a place of darkness, but I love what patients are doing with it. I love it.

Ginger Garner PT, DPT (32:38)

And

just to validate everybody who’s feeling that out there that anger is a positive emotion. It’s a fueling emotion, obviously. It’s a catalyst for many great things. It also brings up an important point about recognizing that once you have sat with and felt anger for so long, you realize that a lot of that is also fueled by and comes from grief.

Adam (33:05)

Yes.

Ginger Garner PT, DPT (33:06)

having had to suffer for so long. That brings up another important question. Then I wanna shift and talk more about like the trauma aspects of what happens to when there’s been delayed diagnosis. But in your take, can you explain that impact of delayed diagnosis and inappropriate treatments?

all kinds of things where they just are on stuck on hormone suppression and thinking that that’s gonna be the thing, right? That stops it and we know that that’s not true on that long-term health of patients with endo. And what would you encourage, what you’re encouraging words be to them? Because I’m not sure if people who are listening might then understand, can just wait for a while, et cetera.

Adam (33:54)

Yeah,

I mean, the impact of delayed diagnosis is absolutely huge on a twofold aspect. mean, one is the fertility aspect of it, right? And the longer that this stuff sits in there, generally, the worse it gets, right? And so when you put patients on these hormonal suppressions and whether it’s birth control or the other more powerful ones,

you know, you’re not really stopping the disease. and, and I think that’s a nuanced, but critical difference that, that none of these medications are designed to treat disease. They are designed to treat symptoms of disease. And when you put a patient on XYZ, that disease is still there. The symptoms might be better, but the disease is still there. And so,

You know, in a world where 50 % of patients with endometriosis will go on to have subfertility or infertility, to put these young patients’ fertility down to a coin flip, I think, is barbaric. And I often get accused of doing unnecessary surgery. And to me, David Redwine taught me years ago, there are two indications.

for surgery, one is for pain and one is for fertility. If neither of those are there, then you don’t have to do surgery. But these patients inevitably, despite being on hormonal suppression, are still in pain on some, and I’m not saying surgery is perfect. not, you know, I don’t think that surgery, you know, I’m not gonna say that surgery cures 100 % of patients or patients will never have pain again, but most patients are still hurting.

despite hormonal suppression or their fertility is being eaten away at. And so to just sort of continue to push the hormonal thing, just, don’t get it. I really don’t understand it. And I think what I would say to patients is challenge authority, resist the patriarchy because

Ginger Garner PT, DPT (36:18)

Hmm.

Adam (36:24)

it, you know, just keep seeking answers. I have no problem. I have patients who come to me and they’re like, Hey, you did excision surgery on me two years ago and I’m still hurting. or, know, my pain went away for two years. It’s back for three years or five years or whatever it might be. I would never tell a patient, well, nothing else we can do. So I generally will operate on patients twice.

Ginger Garner PT, DPT (36:48)

Mm-hmm.

Adam (36:53)

If they’re still having, you know, sort of pain that kind of keeps coming back or whatever, then I will usually offer them a second opinion. I will say, Hey, like my ego, I just want you to get better. Like that’s what we want as excision surgeons and we want our patients to feel better. And if that’s not with me, I have no problem with that. But in the generalist world, it’s like this, you know,

Ginger Garner PT, DPT (37:06)

Mm-hmm.

Adam (37:20)

blow to the ego if a patient goes and sees someone else. encourage patients to go see someone else. I’m not, I’m not, you know, God, I can’t fix everything. There are better surgeons than me out there. Absolutely. And I have no problem if a patient wants to pursue that. I encourage it. I send patients all the time, not all the time. shouldn’t say all the time. That sounds bad, but I send patients very frequently to Mosbrucker and Fogelson and Shanti and Arrington and Sinervo and

Ginger Garner PT, DPT (37:24)

Yeah.

Adam (37:48)

because I know that there are people that are great surgeons out there. And if they can’t, you know, and I’ve operated on their patients too, like none of us are perfect. None of us are, you know, have a hundred percent cure rate. But I have absolutely no problem with a patient challenging my authority and saying, you know, hey, this isn’t working. I need to go see someone else. Great. I would encourage you to do that. So I would encourage all patients to

Ginger Garner PT, DPT (38:01)

Mm-hmm.

Adam (38:18)

not just accept this status quo of this is just how it’s going to be. Seek answers, seek alternatives, talk to people, find a different surgeon, know, question authority. You do not have to take this disease lying down.

Ginger Garner PT, DPT (38:23)

Mm-hmm.

Yeah. Yeah. Yes. I wanted to like fist pump as you were saying all that. So that take home is essentially to say that the red flag situation here is if you are talking with your provider and they are resistant to you seeking a second opinion and they seem to put forth the attitude that they know best and that you don’t need anyone else, you don’t need to talk to anyone else, that would be a giant red flag.

to find a better provider because there are plenty of good providers out there for sure. So one of the questions I have not asked in the lineup of talking to, I will be talking to many, many surgeons in our lineup this season. But one question that I have is, you know, many patients don’t even, they have no idea what a typical excision surgery

you know, means, what it looks like, what factors you consider, what creates the best outcomes for your patients, what even happens as you’re doing that? Can you walk us through that?

Adam (39:47)

sure. So, I mean, you know, starting at the beginning is, is, is seeing that patient in the office for a new patient consult validating what they’re experiencing, validating their symptoms. you know, the physical exam imaging, virtually a hundred percent referral to pelvic floor PT. and then, you know, the, actual

kind of surgery takes place. surgeries can be short, they can be long. Preop imaging is very helpful. We order a lot of MRIs on our patients. And then you go through the surgery and then two to eight weeks of kind of pelvic rest, depending on what was done, hysterectomy, not hysterectomy. And that’s a different unrelated topic, but.

and then it’s generally back to PT. I tell patients, are hard. are not, excision surgery is not you wake up the next day and all your pain is gone. It doesn’t work that way. And I think, and I’m very upfront with patients on that. If you’re looking for the instant cure, this is not it. Because I think after excision surgery, I think that’s when the hard work starts. And I tell patients, it’ll be three to six months, maybe a year.

before you feel back to normal. There’s so much inflammation that goes on. There’s so much change in the regulatory system around the GI tract. There’s so much sort of remodeling, so to speak, that has to go on inside the body. so it is not a quick, next day you feel amazing. These are tough recoveries, they’re long recoveries.

everything has to just kind of settle out over time. And that’s where the pelvic floor physical therapists are so helpful in reiterating that to patients, reiterating the healing process and how this has to all, you know, shake out essentially.

I don’t know if that answered your question. That’s what I’m going for, but.

Ginger Garner PT, DPT (42:02)

Yeah, it does. It kind

of like spawned two more thoughts for me. The first one was a question I was going to answer, which you just answered anyway, which is about the kind of the multidisciplinary, multimodal aspect of it. Because I think a lot of patients would think, excision, I’m done, I’m gone. I’ll be back to work in what, two weeks, I don’t need any therapy for that. And so…

One of those is to say, it definitely takes a village to do all of this. And the one thing that I would encourage listeners to take away with them is that it is not a quick recovery. You need to take extended time off from work. It is gonna take up to a year for you to feel normal, but that normal could be horseback riding or something that you absolutely love that have getting back into or jogging or whatever it is, activity-wise.

Another thing that you pointed out that I think patients get confused about all the time is thinking that let’s just take a typical scenario of a patient that comes in and how many times have they been to the ED, you know or the ER for pain. And to differentiate how, you know, going to the ER, ED, what ends up happening when they cannot identify endometriosis, obviously, and yet a patient may think,

but I had an ultrasound, I had an MRI, and now you’re gonna use it presurgically, right? So talk to us a little bit about the difference between what you’re doing to maybe guide what you’re doing, you know, presurgically versus thinking that they can drop into the ED and then being confused because they never find anything. Yeah.

Adam (43:44)

Yeah, because they had a negative ultrasound.

I mean, you know, we’re kind of doing targeted ultrasounds. mean, we have a great, very robust radiology department here at our hospital. We’re a small hospital, but we’re one of the last physician-owned hospitals. And my partner, Dr. Young and I, are both have been very fortunate and able to sort of be owners of this hospital that we run. There’s five spine surgeons, eight

orthopedics, a few general surgeons, and then my partner and I. So we’re a pretty small hospital. The point I’m making is that everybody knows everybody, right? And we have a couple of just really awesome radiologists who are here on site all the time, and they are the ones reading my scans all the time. Most of the images, my partner and I also, we review them ourselves, but I am constantly swinging by my radiologist’s little

Batcave over there and sitting with him, Dr. Griffiths is his name, awesome radiologist, and he gets it. Like he knows what we’re looking for. And we go through those images all the time together. And so the difference between, you know, when you go to an ER, their only job in an ER is to make sure that you are not going to actively die in the next 24 hours.

Ginger Garner PT, DPT (45:06)

Mm-hmm.

Adam (45:06)

and you’re out the door. So they’re not

Ginger Garner PT, DPT (45:08)

Yep.

Adam (45:08)

looking, they’re not doing these deep scans, these MRIs, they’re not doing that, they’re just making sure, is there something that’s gonna kill this patient in next 24 hours? If it’s not, they’re out the door. And so that’s the big difference in terms of what we’re looking for on imaging. that leads me to a little bit of a point, I think that patients…

Ginger Garner PT, DPT (45:20)

Mm-hmm.

Adam (45:34)

two points that I’m going to make actually out of this. A lot of patients, you know, will come to me and say, yeah, I’ve had negative imaging. You know, all my scans have been normal. To me, the presence of pain in the absence of a positive scan, you know, that’s endo until proven otherwise. And the flip side in the OB-GYN world, they order ultrasounds of patients say, well, it’s negative, it must not be anything endometriosis, but we know that the

Ginger Garner PT, DPT (46:02)

You

Adam (46:04)

imaging sensitivity is less than ideal in the wrong hands. And so to use a negative image and say, well, your ultrasound is normal. It must not be endometriosis. It must not be a gynecologic process. Maybe you should go see GI. Maybe you should go see psych. Maybe you should go see whoever is really irresponsible. And to me, as I said, a negative imaging workup, if there’s pain there,

the negative imaging workup to me is almost more reassuring that there’s endometriosis there. And that a lot of patients when they come and they have been told by their OB-GYNs for years and years and years and years that they don’t have endometriosis, they don’t have endometriosis, they’ve almost gone through this gas lighting process of themselves. And then they don’t believe me. Some of them don’t believe me.

Ginger Garner PT, DPT (46:41)

That’s huge.

Adam (47:02)

Some of them say, what makes you so sure? How can you say that I have endometriosis when six other doctors have told me that there’s no possible way I have endometriosis? And so they don’t, a lot of times don’t even believe me. And guess what we find on their surgery? Guess we find 100 % of the time, endometriosis. I have never taken a patient to the OR that I’ve said 100 % you have endometriosis based on everything you’re telling me.

Ginger Garner PT, DPT (47:05)

Wow.

Yeah. Yeah.

Mm-hmm.

Adam (47:32)

and not found it. The pathology reports are wrong sometimes, but there’s pictorial evidence that there is endometriosis in you. There it is. So I think that’s incredibly validating for patients.

Ginger Garner PT, DPT (47:39)

Yeah.

Yeah, you know, everyone listening, it’s like you, you’ve just said something that was so incredibly important that, you know, the negative scan and negative image, whatever, could be even more supportive that endo is present when pain persists in the evidence of, you know, negative results for diagnostic imaging. So I get that question a lot from patients because they are so frustrated and prior to surgery, they will have all of these flares and then

That’s where I’m like, I will work you in if I can see you because if you end up in the ER/ED again and again and again, it’s not getting anywhere and they’re not looking at imaging in the same way as you are looking at imaging presurgically. And so I just want everybody to take home that message and realize that there are pain management strategies too that hopefully can keep you then out.

Adam (48:20)

Thank you.

Ginger Garner PT, DPT (48:40)

of the ER and the ED, which certainly saves you lots of time, lots of potential gas lighting and a lot of money at the same time. So thanks for making that distinction.

Adam (48:48)

Or you get

labeled as a narcotic seeker. The number of patients I have that have narcotic seeking on their ER charts is a lot higher than you think.

Ginger Garner PT, DPT (48:54)

Yep. Yeah.

Yeah,

it’s awful. It’s really awful. So thank you for making that distinction. I think that’s a huge take home for people who are really frustrated with getting stuck in that cycle of being bounced around to different providers and then thinking that imaging is going to get them somewhere without seeing someone who is truly an excision expert. So I have a couple of final questions. If there’s any…

innovations, advancements, things that, you know, in the field of Endo that are, you know, exciting or that you think that you’d like to see, you know, for the future of care in Endo. I know we have a lot of the wish list is long, but what gets you excited?

Adam (49:50)

The wish list is long. think what gets me excited is seeing more recognition of disease, is seeing, because that’s where it’s really going to start. And I have a great relationship with a guy here named Mike Baker, and he runs Heritage Health, which is a chain of health clinics for kind of underserved, underinsured population. And Mike is a

fierce advocate for endometriosis for personal and familial reasons. Mike was at the endosummit. You’d recognize Mike. He’s a lovely guy. But he has made it his mission to educate his primary care providers and his pediatricians on the signs and symptoms of endo. And then if you have patients who have bloating, nausea, vomiting, diarrhea, constipation, pain, pain with

painful intercourse, painful urination, painful bowel movements. It’s not IBS. It’s not anxiety. These are real symptoms of a real disease. And if you have all of those symptoms, you don’t need to see GI. You don’t need to see a psych. You don’t need to see general surgery. You need to see a specialist. And Mike has really made it.

sort of his mission. And I’d love to see more of that on a national level, that education, because that’s where it’s gonna start in the pediatrician’s offices. And I’ve gone and I’ve given talks to the pediatricians and they’re blown away. They have no idea that gastrointestinal distress in teenagers, especially with cyclical nature is endometriosis and don’t prove it otherwise. I I went and gave a talk to a local pediatrician office and they said,

Ginger Garner PT, DPT (51:18)

Yeah.

Adam (51:38)

you just blew my mind. The number of 15 and 16 year olds I sent for colonoscopy last year for these exact same symptoms and I’m going, my God, you know? So I think that’s where it’s gonna start. And that really excites me is that education of primary carers and pediatricians, school nurses, that’s where Shannon Cohn is a rock star and I love Shannon, she’s awesome.

Ginger Garner PT, DPT (51:40)

wow.

Yeah.

Yeah.

Adam (52:02)

you know, that school nurse initiative to educate school nurses on the signs and symptoms of endo. So when these girls are coming in, you know, with all of the things that are so obvious to me and they’re so obvious to you, but they’re apparently not obvious to everybody else. That’s really exciting from a technical standpoint on endometriosis. I I think the thing that really excites me most is the idea eventually of being able to sort of genotype

Ginger Garner PT, DPT (52:10)

Mm-hmm.

Yeah.

Adam (52:32)

endometriosis, we know that there are over 300 genes more. It’s been a long day or long evening. Hundreds of thousands of genes that are still being identified that contribute to the expression of endometriosis, the point I’m trying to make. we have long recognized that cancer is not just cancer, Pancreatic cancer, breast cancer, ovarian cancer,

Ginger Garner PT, DPT (52:46)

Yeah.

Mm-hmm.

Adam (53:01)

prostate cancer, they all behave very differently from one another. They all express different genetic components. For years, we’ve always just lumped endometriosis. All endometriosis is just endometriosis, but we know that there are various types of endometriosis. Why do some patients get more pain? Why do some patients have really aggressive DIE or deep infiltrating endometriosis?

Ginger Garner PT, DPT (53:22)

Mm-hmm.

Adam (53:29)

and others don’t. And why do some patients have infertility or subfertility and some patients don’t? that to me, I think will be the holy grail of endometriosis care is that if we can, there’ll still be a role for excision. If we can go in and excise endometriosis and send it to a lab and have it like genotyped and say, these are the genes.

Ginger Garner PT, DPT (53:46)

Yeah.

Adam (53:53)

And a lot of these genes that are contributing to the expression of endometriosis are the same genes that are contributing to development of cancers, natural killer cells and T cells and macrophages and inflammatory cells. And there’s a lot of crossover. And we put so much of the emphasis on genotyping into the cancer world. We haven’t done it in the endometriosis world. that would be the exciting aspect to me would be, is if we can genotype

Ginger Garner PT, DPT (54:00)

Mm-hmm. Mm-hmm.

Adam (54:23)

the various types of endometriosis and then potentially do targeted gene therapy. So there’s still a role, we’re now treating endometriosis like a cancer and that we’re going in, we’re excising, know, we’re debulking as much of the disease, as much of the cancer, as much of the endometriosis as we can, and then killing off any residual endometriosis with gene specific therapies or preventing recurrence with gene specific therapies. I mean, that to me,

would be, that would be absolute game changer. But we’re a long way off because this is a quote unquote women’s issue.

Ginger Garner PT, DPT (54:54)

Yeah.

Yeah.

Yeah.

we could have a whole other podcast on that for sure. Yeah, I think that I am equally as excited about that knowing that we have phenotypes for so many other things, including pelvic organ prolapse. And then we have these other overlapping issues like hypermobility syndromes and POTS and things like that that go along with it. It’s just, it’s very encouraging, it’s very promising. I just wish that we could skip like…

ahead. Press the fast forward button.

Adam (55:35)

Yeah. I

think the most, to me, a really exciting breakthrough would be a really sensitive way to image endometriosis. If we had something similar to a PET scan for cancer where we could radioactively tag a protein or a sugar molecule or something that is specific to endometriosis that gets eaten up by endometriosis,

Ginger Garner PT, DPT (55:48)

Yeah.

Adam (56:05)

it would put to rest this idea of no, you don’t have endometriosis because if a patient comes in and they’re complaining, a pain and I’m not talking to me, I’m talking to the generalist or the family practice, wherever it would put to bed this notion of no, you don’t have an endometriosis. I’ve never seen a group of physicians as a whole go to such great lengths to convince patients that they do not have a disease.

because the second that they diagnose you with that disease, they have to deal with you and they don’t know how to deal with you. So they go to great lengths to convince you that it’s gastrointestinal, it’s a general surgery problem, it’s in your head, maybe you’re just anxious, maybe you’re not sleeping enough, maybe you should just have a glass of wine and try to relax every once in I we’ve heard all the BS, right? We’ve all heard the same lines. And so if we had…

Ginger Garner PT, DPT (56:37)

Hmm.

Mm-hmm.

Yeah. Yeah.

Adam (56:59)

an imaging modality that was 100 % accurate, would just put all of that, all of that would go away because you just do a scan, patient has endo, they don’t have endo. Done. And then the patient knows. And they don’t have to endure years and years and years of being told that it’s anything but endometriosis.

Ginger Garner PT, DPT (57:10)

Yeah.

Yeah.

Right, the five, the 10, the 15,

the 25. Gosh, yeah, in my case it was a forever and ever and ever. One of the things that I’m also excited on the other end of that, on the treatment aspect of it is, and there is a paper out on it recently, is the gut microbiome and really determining what lesions are doing to the gut microbiome and what we can do about that.

Adam (57:41)

to hear.

Ginger Garner PT, DPT (57:45)

And that kind of rests in the lifestyle medicine aspect of therapy and helping them recover from nutrition to how we can populate the gut bacteria in a positive way. Yeah. Yeah.

Adam (57:55)

Yeah, Shanti does Shanti Mohling does a lot with that. So Shanti and

I, I don’t know, we trained at the same program. So we were both under the tutelage of CY Liu, Scott Furr, were kind of CY was, and that’s Laurie’s dad, you’ll interviewing Laurie. So CY was a mentor to me. He was a mentor to Jeff Errington, Scott Furr, who then trained, you know, me and Shanti and Rayan Alcate, who’s going to be joining.

Iris Orbach, he has joined Iris Orbach down there in California. So I mean, this great litany of endometrial surgeons that have come out of this Chattanooga program. But Shanti is, that’s her big, that’s her jam is the leaky gut and the gut microbiome. And yeah, she is all over that. It’s fascinating.

Ginger Garner PT, DPT (58:46)

I was so excited to

see that that was included at the end of summit last year. Yeah.

Adam (58:52)

Yeah, that was a great talk. Yeah, Shanti,

Shanti’s, she’s, she’s one of my favorite people on earth. I mean, she’s just so she was the in fellowship, the year behind me. And so we’ve known I’ve known Shanti for, gosh, 10 years now. And she’s just, she’s lovely, right? She’s just such a great person. And I’m so glad that she’s doing that work, because I, I have zero interest in doing any kind of basic science research, I just

Ginger Garner PT, DPT (59:13)

Yeah.

Adam (59:21)

I’m not smart enough. I don’t have the brain for it. I’m really not. So I’m a cutter. I just need to be in the OR. And so I’m glad that people are doing that work because I think there’s such a role for it, right? Yeah.

Ginger Garner PT, DPT (59:24)

my gosh, you can’t say that.

Yeah, there’s so many areas

of research that are needed and it’s just like impossible to cover. So we have to divide and conquer. All right, last question. I absolutely promised last question. And thank you, thank you, thank you for your time. I wanna hear what you have to say to medical students, residents who are interested in specializing in endo, but.

Adam (59:42)

Absolutely.

Yeah.

this has been fun.

Ginger Garner PT, DPT (59:58)

because they probably have their own challenges, you can speak personally to that. What advice do you have for them?

Adam (1:00:05)

For those wanting to specialize in it, I would say don’t just sort of take what the books are saying. Don’t just take what your professors are always saying and seek out. It’s so easy to find specialists. I have people come observe surgeries all the time. mean, I have…

Ginger Garner PT, DPT (1:00:08)

Mm-hmm.

Adam (1:00:30)

general OBGYNs who want to come in and watch me do surgeries. And I love that because then they’re seeing what I’m doing. I’m not, you know, we’re not making it up that we’re doing these really complex surgeries at a level that they’re maybe not doing or that they’re not doing. And so I love seeing OBGYNs. I’ve had high school students come in and watch me who are interested. I mentored a kid a couple of

years ago, she’s now down University of Arizona. And her entire goal is to become an endometriosis excision surgeon. She knew that at 17 because she spent a summer watching me in the OR. And so things like that. just like seek out a specialist and watch them go watch what they do. And I’m going to be writing her letters when it comes time for letters of recommendation to get into med school. She’s going to be applying, I think, at end of next year.

Ginger Garner PT, DPT (1:01:09)

Wow.

Adam (1:01:27)

So that would be the advice that I would give to medical students. You know, PTs is if you’re interested in this kind of stuff, go watch somebody do this type of surgery and really get a grasp of what we are doing and the complexity of what we’re doing. Cause it’s, it’s, it’s pretty amazing. And, and any of these guys, you know, I’ve, I’ve, I’ve watched some of these surgery videos and things, and I’m, continuously like blown away at the

what we’re doing as a specialty in this world. And I get as excited about watching surgeries sometimes I do doing surgeries, you know, just watching really top-notch surgeons. I still learn things all the time when I go to AGL or the endosummit, I’m seeing these surgical videos. I’m like, that’s a great way to approach that. I’m going to incorporate that next time. So we’re all constantly learning. We’re all constantly trying to do the best we can. We’re all constantly trying to improve ourselves and get better as surgeons.

Ginger Garner PT, DPT (1:02:17)

Yeah.

Adam (1:02:25)

And we do that in this world by learning from each other. And none of us who are doing MIGs have gotten where we are without a mentor. We’ve all had to have a mentor to get where we are. Mossbrook was under David Redwine, know, Sanerbo and Albie. like, there’s just, it’s just this, this tree of we’re all under, you know, they talk about NFL coaching trees and things, you know, we’re all learning from.

Ginger Garner PT, DPT (1:02:42)

Mm-hmm. Mm-hmm.

Adam (1:02:55)

the CYL go back far enough and it’s the Harry Riches, the CYLuz, the David Redwine’s, the Dr. Alviz, you know, and it’s just, it’s so amazing to see that we’ve all sort of come up under this umbrella of these giants, frankly, that we’re standing on the shoulders of. And it’s, but we’re all learning from each other. And think like, that’s what love so much about the Endos Summit is I just geek out there. I can,

Ginger Garner PT, DPT (1:03:14)

Yeah.

You

Adam (1:03:25)

I can go and I’m with my people. I’m with my people and I can talk about endometriosis all day long and not just bore the hell out of people like I do here. You they’re like, God, he’s talking about endometriosis again. You know, cocktail party. there’s that endometriosis guy. I talk, but I can go down to the EndoSummit and I’m just with my people and I love that. And I learned so much from those surgeons down there. So I would say to the students who,

Ginger Garner PT, DPT (1:03:27)

Yeah.

Yeah.

Adam (1:03:54)

want to do this, find a mentor and we’re out there. I don’t, I mean, I don’t have a fellowship program. don’t, you know, but like, I’m happy to have people. have a physical therapist, a generalist, students come watch me all the time and just observe cases. And I’m happy to take people all the time.

Ginger Garner PT, DPT (1:04:11)

Thank you so much. I thank you for doing that. Thank you for being the mentor and bringing up the next generation. It’s essential, especially when it’s still such a fragile, like vulnerable time for endometriosis in the medical community. And there’s still so much to be learned. There’s still so much advocacy work to be done. So I just want to thank you for that passion and how you are consistently just…

I mean, keeping on keeping on starting like with the full circle mention of all those cases that you did in December. So thank you, Dr. Adam Duke for coming on today.

Adam (1:04:46)

Yeah,

you’re welcome. It was wonderful being on.

Ginger Garner PT, DPT (1:04:50)

Yeah.

Adam (1:04:52)

Take care.

Ginger Garner PT, DPT (1:04:54)

You too.