Case Study: Endometriosis with Federica Torri and Dr. Jessica Drummond

Dr. Jessica Drummond (00:00:03) – Hi and welcome to the Integrative Women’s Health Podcast. I’m your host, Doctor Jessica Drummond, and I am so thrilled to have you here as we dive into today’s episode. As always, innovating and integrating in the world of women’s health. And just as a reminder, the content in this podcast episode is no substitute for medical advice, diagnosis, or treatment from your medical or licensed health care team. While myself and many of my guests are licensed healthcare professionals, we are not your licensed healthcare professionals, so you want to get advice on your unique circumstances. Diagnostic recommendations treatment recommendations from your home medical team. Enjoy the episode. Let’s innovate and integrate together. Today I have a very special guest for the Integrative Women’s Health Podcast. Hi there, I’m Doctor Jessica Drummond, I’m your host, and today we’re going to be meeting Federica. She is here to share her story as a case study for you to learn how we navigate complex chronic illness such as endometriosis, in her case through the health coaching lens, how we integrate her multidisciplinary team and her day to day health behaviors to help her overcome and live healthfully, even in the midst of having a complex chronic illness and Dimitrios and recovering from complex excision surgery.

Dr. Jessica Drummond (00:01:51) – Skilled excision surgery for her endometriosis. So join me in listening in and look out for the step by step of our seven step system for how we work with any women’s health, chronic or acute illnesses that we’re collaborating with our clients through that coaching mindset, coaching perspective and, you know, coaching integration into their actual life, not just giving them a list of things to do to get well, but really integrating it within her life, her vision, her values. So let’s dive in. Oh, and remember, while I am a licensed clinical nutritionist and licensed physical therapist and board certified Health and Wellness coach, I am not yours of any of those. And so take this as general information for your own health. Please follow the recommendations of your own clinical or coaching health team wellness team. And don’t delay any therapies with them due to any educational materials that you might hear on this podcast. If you would like to apply to be a guest case study on our podcast, please send an email to support at Integrative Women’s Health Institute.

Dr. Jessica Drummond (00:03:18) – Com that support at Integrative Women’s Health Institute. Com and just simply put in the subject line application to be a case study on your podcast. Let’s dive in. Welcome back everyone. I’m Doctor Jessica Drummond, your host of the Integrative Women’s Health podcast. And I’m here today with Federica. She has come to give us her story of her own healing, to show you how, as a women’s health or wellness coach, you can be approaching these more complex cases. So we’re going to lead with a coaching mindset, and we’re going to integrate various clinical strategies, which you can employ depending on your licensure in your state or your country and also just your level of training. So for example, we know that physical therapists in the United States can utilize nutrition strategies for healing things related to the physical therapy diagnosis, assuming they have the level of functional nutrition training to do that, because it’s not always offered in our entry level, you know, physical therapy licensure training. So that’s one example. If you’re a nutritionist, a dietician, gynecologist, functional medicine practitioner, any of the letters behind your name, you’ll be able to use some of these tools.

Dr. Jessica Drummond (00:04:51) – And for others of you, if you’re fully leading with the coaching mindset, whether or not you have any other letters behind your name, you’re always. Still doing this in an educational model because what we want is that our clients. So in this case, Federica is going to be actively engaged in the process. This is not going to be me telling her, okay, you have to do X, Y and Z, and that’s going to solve your problem because this is a very much an interactive experience. All right. So thank you and welcome. Thank you for being here. And Federica, could you start us off with sharing the story of when you last felt well and then what’s been going on with you physically for the last few years.

Federica Torri (00:05:36) – Yeah, absolutely. So the memory about me feeling well for more than a few days, it goes back to, I think more than ten years ago, I think before I moved to the US, because I’m originally from Italy, born and raised, and one year after I moved to the US, I started having debilitating pain with my period.

Federica Torri (00:05:58) – And keep in mind that before when I was in Italy, I had some symptoms around sexuality. So I had some pain with sex, mainly urinary symptoms, but I never had an issue with my period. And so in the last 12 years my symptoms have been very unpredictable. I had entire years where I was more or less fine, but I’ve always had lots of unexplainable periods of very strong GI symptoms, and it meant having lots of pain, going to the bathroom, becoming all of a sudden constipated, even functionally constipated like my system shutting down. And so it has been a very traumatic journey because I went around for 12 years with no one even mentioning endometriosis really as a word, and I tried really everything. I am a learner at core, so this is the reason why one year ago I actually studied at the integrative like Women’s Health Institute, trying to become my first patient, my first clients in a way, and I’ve been using lots of tools in my toolset pelvic floor therapy, changing nutrition supplementation.

Federica Torri (00:07:08) – Yeah, like regulating nervous system. But the last year and a half has been the hardest in my entire history. It became a continuum. I didn’t have one day of not feeling excruciating pain. And so it has been a year where they tried lots of things on me, lots of hormones and things went down the hill. Finally, in December last year, after 12 years of going around the world, I finally found an endometriosis specialist. And so I had skilled excision surgery last year and my life has improved. I tried not to have attachment to the outcome of the surgery. I have to say it is improved, but still I don’t have a great quality of life. So I am definitely trying to learn as much as I can about anything else I might be doing.

Dr. Jessica Drummond (00:07:57) – Yeah, thank you for sharing that. So it’s been a little more than a decade, 12 years since you moved from Italy. About a year later, you started having period pain, possibly had active endo even in Italy, but the symptoms were much lighter and mostly post sexual urinary symptoms.

Dr. Jessica Drummond (00:08:19) – So finally, after a lot of GI symptoms, period pain, you know, coming and learning what endometriosis was from us and a few of your finally some of your practitioners started to say and endometriosis you had excision surgery in October of 2023, correct? Yes. Correct. Okay. And I think this is a really important point. So October of 2023, we’re now in early February 2024. So it’s only been four months ish. And one thing that I think many people don’t realize, and people are often not prepared for if they do have endometriosis surgery is two things. It’s very helpful, and it sounds like you did some of this, but by then your symptoms were really wound up to have physical therapy and nutrition and coaching counseling pre surgically, usually for 3 to 6 months, with the goal being to settle the nervous system activation, which is a lot of times easier said than done and can take some pretty intensive coaching and work and down training. And it depends on what else is going on in your life, which we’ll get into that in a minute.

Dr. Jessica Drummond (00:09:32) – But ideally we want to be as low, inflammatory, calm and relaxed about the surgery as possible. Is that easy to do? No, it’s very difficult because most people, like you have had a decade of medical trauma and constant extreme symptoms. And it’s also frustrating because we often don’t know. And there are some technologies in the works to try to have better diagnostics. Endometriosis that are not so invasive. But the reality is that the current moment to be diagnosed with endometriosis, you have to have surgery. That’s the only real way to know for sure whether or not you have endometriosis. Now, if they do see it on imaging, then you have it so that in some ways can be calming because it’s like finally, okay, I have a thing to put this on, but most people go into surgery and tell us if this was your experience, not knowing whether or not you actually have a new ptosis.

Federica Torri (00:10:34) – Yeah. So that’s why I like to say that this is the upside down world, because you wake up from the surgery hoping that they found something, and in my case, they could see some fibrosis in the MRI.

Federica Torri (00:10:48) – So it was pretty suggestive that deep infiltrating process going on. But they didn’t see, of course, the extent. So my experience was that when I woke up, I kept on asking, did you find it? And the surgeon was like, yes. And he gave me the entire footage. And and it was very healing for me, even if it seems weird that you want to see that. But definitely I didn’t know for certain the extent what they would have found. They can find also like endometrium, they could find some things that are also not great and they might have to remove part of you. So yeah, it’s a huge, huge question mark. It takes a big toll to go there.

Dr. Jessica Drummond (00:11:30) – Yeah. Absolutely. So tell us a little bit to so you go into surgery like many people with that question mark, you had strong suspicion because of the MRI and some of the imaging, which is a little bit affirming. Then you come out and you’re like, okay, this is real.

Dr. Jessica Drummond (00:11:45) – It has a name. It’s something people understand to some extent. And in your case, it was very severe. Stage four deep infiltrating endo in the bowel or.

Federica Torri (00:11:56) – It was not infiltrating in the intramural of the bowel. It was deep fibrosis of the pelvis. So it was not a frozen pelvis but close to it.

Dr. Jessica Drummond (00:12:06) – Yeah. Okay. So all over the pelvis, pelvic organs, soft tissues, fascia. And we’re going to come back to that word fascia in a little bit because it’s part of the nervous system regulation. We think of the brain as being the nervous system. But really there’s all of these peripheral nerves in the fascia that are a key part of the conversation. All right. So if we back up a bit to just before the surgery and even a few years before the surgery, one of the reasons why I said it’s easier said than done to just have this calming, you know, my guess was you weren’t laying on a beach in Fiji for the year before your surgery. I wish what were you doing? What was your life like? Yeah.

Federica Torri (00:12:55) – I had a very similar conversation with my best friend. This is why I’m laughing. So there before has been a very pivotal year for me because I been working in tech. I have a scientific background. I was a researcher before, and then I worked in tech for ten years, and I had a very, very stressful, super high profile, very stressful position. And I came to the decision to leave it last January, actually 2023. There were also some things happening in the company, but also I was not in a good state to do it. And also I really needed to look for my purpose because I wanted to serve another kind of mission. And so I took one year of work, and my year definitely didn’t look like being at the Fijis people are like, oh, so cool. You had a sabbatical year. I was in so much pain. They tried multiple hormonal approaches on me and I had rashes, gained tons of weight. I was settled at the time like progesterone. Really like big doses of progesterone to don’t do well to my brain.

Federica Torri (00:13:54) – But in all of this being a very learning oriented person, I wanted to give a meaning to this time. And I didn’t do it consciously. I realized it now, but I studied at two school. I studied well coaches as a health and wellness coach. I started a yoga teacher training. I know it sounds crazy, but I really started pivoting so that my pain could become meaningful and I could just do something for others too. And so I started doing advocacy. So it’s definitely been a intense year, not a happy one, but I found a lot of meaning and now I can appreciate when I was in the midst of it, I have been at my worst. I really wanted to cocoon. I wasn’t really going out or being. I was really like in my pain body. But it was a lot.

Dr. Jessica Drummond (00:14:45) – Yeah, no, that’s very valuable because I think one of the things that’s so common about your story is that so one, it’s valuable that you had the opportunity to be able to leave that stressful job, but also.

Dr. Jessica Drummond (00:14:59) – That was what your body was just kind of used to. That was your schedule. That was where you learned to mask the pain and the symptoms and keep it together for work, which while isn’t ideal and on many levels, it’s one level of control over the situation. And, you know, I know having had a really complex experience with long Covid, I too, and many people do try two things. One, sometimes work is an anchor that can keep you at least stable because you have to keep kind of showing up. So there’s some benefit to that. If you have the opportunity to leave a high pressure situation and take care of yourself, that’s also valuable. But I think a lot of times no one tells you how to do that. And so what we often do, and I did the same thing in early in my long Covid journey is I became like the education chair of the long Covid physio thing. You know, I was trying to give talks. We were trying to put together a conference and have advocacy work.

Dr. Jessica Drummond (00:16:02) – There’s danger in that and I was able to see it pretty quickly for myself because of my experience for 25 years working with people with endometriosis and vulvodynia and other really severe chronic pain issues. The benefit is you have a community that does kind of understand what you’re going through at many levels. So they believe you. They don’t think you’re crazy. They know this pain is real. They know these symptoms are real, but it keeps you identified with the disease. And so after about six months of realizing I just didn’t have the capacity to do that. And it sounds like you learned a lot of skills and you learned a lot of meaning, and there’s real value in that, but it doesn’t actually help the symptoms in many cases. Is that what your experience was?

Federica Torri (00:16:55) – Yeah, I have to say that I notice, especially social media, for me are very difficult because my brain is a very fast paced brain. And social media, I mean, I think can be like this for everyone, but my experience is that it gets under my skin, and especially in the account of the coaching practice that I started for women with Endo, of course, the content that comes up is always about endo, and I really feel it that I can take it up to a point and then it becomes obsessive, like I feel again that that’s all my life.

Federica Torri (00:17:29) – And so I try to implement strategies, for example, being on social media only on Tuesday. Right. The other piece is the support groups. It’s true. It’s a double sided sword, right? Because it gave me lots of support. But also I end up in that very obsessive, oh my God, oh my God. Being also an empath, when these people share their pain, it’s like it’s really opening up my mind constantly. And so definitely it’s difficult. The part that gives me energy still is the advocacy piece in terms of going and speaking at a conference, I’m trying to help, for example, the group, the center for Endo here in Boston that did my surgery because I’m incredibly grateful. And so that gives me energy because that’s also brings my scientist side. I can do research. But yeah, the other things I agree, I would agree that too much as not allowing me to remember that. Also, I have a life.

Dr. Jessica Drummond (00:18:24) – Yeah. And so I think this is something that each individual has to navigate a bit for themselves.

Dr. Jessica Drummond (00:18:31) – Because what’s hard about this is of course, if you aren’t in the world of chronic illness or you’re not a clinician of endometriosis, in which case you’re very busy all day with endometriosis patients or a coach of endometriosis, or you have endometriosis, or the family member of an endometriosis patient who’s going to do the advocacy right, like some of us have to. Same thing with any chronic illness. So there’s that. So I think a big bow of gratitude for people who do sacrifice some level of their own health to do this work for others in that situation. And then I think it’s just important to have some awareness of this so that you can make a decision about that with almost like true informed consent, because a lot of times we’re just sort of thrown into it rather than being like, oh, wait a minute. You know, at one point you said just a minute ago it was getting under my skin like it was physically harmful for you and emotionally harmful for you to carry the pain of so many other people while you’re not really in a stable place yet, like you’re trying to get ready for surgery, right? So I think it’s all of us have to make these very subtle decisions for how much or how little and when the timing is right.

Dr. Jessica Drummond (00:19:54) – And so if you’re listening to this and your patients are struggling with endometriosis, but. You don’t have it, you’re very stable or some of them are on the other side and are very stable and are feeling really well. Maybe that’s the place to do some advocacy. And I think it’s very important that from a coaching mindset, you put some boundaries around that, even if it’s, you know, yes, you can absolutely have an endometriosis social media account on Tuesdays only.

Federica Torri (00:20:24) – The Tuesdays social. That’s right.

Dr. Jessica Drummond (00:20:26) – And maybe we agree, like once a week is the max. Anyone can be expected to be on a chronic illness, social media. And I think whatever the boundaries are that feel right for you. And that time just before surgery, coming back to this as a clinical example, is a really valuable time for people to create like a nest of safety and support because you’re building that pre surgical and post-surgical nest. So some of the things that I use are some homeopathic strategies is to start settling the nervous system.

Dr. Jessica Drummond (00:21:02) – There is an array of tools that we can all use breathwork, mindfulness, slow movement practices. There’s probably some real benefit in you doing a yoga training and maybe thinking of it as just training for yourself as the only client, and then later use it for others. And it sounds like you were really doing that, which is great. So yoga. Yoga is not for everyone. Some people just need to be sitting with their dogs. Some people need to be outside a lot. Some people need to be on the phone with friends. Everyone is going to have different quality strategies for regulating the nervous system. So that’s a really important piece. And then also pre surgically, what you were trying to do I think is lower your inflammation in a number of different ways. And we’ll get into the details of what we want to do now. But that’s also good. Then you have your surgery and post-op. So one of the things I want to circle back to is your four month post. And it’s very normal to just get over the acute pain of surgery in about 6 to 12, 18 weeks.

Dr. Jessica Drummond (00:22:09) – So you’re just through the early acute recovery. It’s very normal to have a full recovery from surgery that takes 6 to 24 months.

Federica Torri (00:22:19) – Okay, I feel better. I’m going to make a note here because this is not what I tell you all the time.

Dr. Jessica Drummond (00:22:25) – Yeah, yeah. This is not what they tell you, but what they didn’t take into consideration. So if in an ideal world, you were in Fiji for ten years, you were like, oh, I have endo very few symptoms. You go into surgery, they take it all out. I mean, your nervous system and your immune system, which is part of the driver of all these secondary symptoms, and your digestive system, which has been infiltrated by essentially scar tissue and facial adhesions and all of that for years, if not decades, just springs right back. A lot of times in functional medicine, we talk about how instead of, let’s say, someone steps on a nail, instead of giving them Advil and massages and stuff, we take the nail out, right? But that’s not always possible.

Dr. Jessica Drummond (00:23:14) – And an endo, I think of the endo as the nail. And for most people, if their endo becomes activated, it can become activated at any point in their life. But in many people that’s, you know, eight, nine, ten, 11, 12 years old. And for you, it might have been very subtly active in Italy 15 years ago, but you had a lifestyle and food access and things that was much less inflammatory than being in the United States. So it didn’t fully activate, but you had some level of the nail in your foot for 15 years. You can’t just take it out. There’s going to be response from the nervous system, from the immune system. They’ll be bleeding. They’ll be scar tissue. If that nail was in your colon or in your pelvis, it’s going to also impacts certain organs that you don’t have in your foot. So it’s not as simple as just take the nail out. So they took the nail out but it leaves behind scar tissue immune upregulation or I would say immune dysregulation because you’re both overreacting to certain things and not always able to clear viruses and pathogens.

Dr. Jessica Drummond (00:24:23) – And gut microbiome gets messed up and your nervous system gets messed up and all that. So now that’s why I think it’s really important. While the surgical wounds might be healed and you’re not bleeding, there’s no complications. Now we have to work on all the systems. So I’ve been saying for 20 years, don’t chase symptoms, optimize systems. Now we just are barely able to start doing that because you’re only four months out. We’re just now the acute surgical wounds have healed. Does that helpful?

Federica Torri (00:24:57) – Yeah. The thing is after. Their surgery. Even if you are working with a team that is incredibly skilled. Of course, the information that the surgical team gives you is that in eight weeks you can do twists. I’ve been working with the functional medicine doctor to in parallel, and I saw the difference between perspectives where I didn’t know up to 24 months. So this gives me even more hope. But it’s definitely the wound is one thing, but the system is definitely a longer process.

Dr. Jessica Drummond (00:25:26) – Yeah. And in a way, 6 to 24 months even is kind of arbitrary.

Dr. Jessica Drummond (00:25:31) – Like if you’ve been dealing with this for 30 years, we’re increasingly seeing people dealing with endo diagnoses in their perimenopause and perimenopause timeframe and their 40s and 50s. You know, you’ve been dealing with this for 30 years without even knowing it, perhaps. So whatever the timeframe was before, it’s kind of like when we talk about recovery postpartum nine months and nine months out. You don’t bounce back in six weeks when you have your follow up appointment. All right. But I also think healing is an upward spiral, right? It’s a journey where now what we can start to be looking for is starting to have some improvements that are maybe not every single day, but some days that are feeling better, some good days, some less intense days. But it’s not going to happen on its own because of all of the other dysregulation that you went into surgery with, and that the surgery itself could flare up. So let’s start talking about those systems. So if you think about your nervous system and regulation, how is that feeling to you now and what are the tools that you’re finding most helpful for that?

Federica Torri (00:26:40) – Definitely, in the last six months since I started my yoga teacher training, that gave me access to a lot of breathing techniques and even just the yoga practice.

Federica Torri (00:26:51) – I’m very interested to the fascia when you mentioned it. And so I’ve been really working with this. I’ve been monitoring my HRV, for example, to really understand, oh, I feel very tired. And look, it’s actually like I mean, I have a Fitbit and I don’t have anything too fancy, but I started trying to not overcharge my system because I tend to be a super enthusiastic person. So as soon as I got out of the surgery, I was like, okay, I need my life back. So I’m pretty regulated. I have very strong mood swings and this IUD, it’s a conscious decision that I came to with the team that’s working with me, because I also have a meiosis and I’m not ready to have any strategy unless it’s strictly necessary. So I don’t have a true like strong period. But I still have ovulation and my mood really spikes. And so there are couple of days a month or more that I am more dysregulated. My dysregulation is very much hormonal, I have to say.

Federica Torri (00:27:50) – So yeah. Progress. I do cold showers, for example, tapping acupuncture like, yeah, I’ve really dedicated lots of time to these things now that I can before going back full on to a full time job.

Dr. Jessica Drummond (00:28:05) – Yeah. So a couple of lessons, a couple of insights. If you can take some time post-op to do that. True healing, maybe ease in part time, maybe take some time off. Easier said than done, depending on what your family situation and financial situation and support system. But the more you can that’s really, really valuable. And then what we mean when we say nervous system regulation, there are three states of the nervous system. There’s fight or flight that’s sympathetic of regulation where you’re kind of always on anxious, jittery, overwhelmed. You know, you’re literally want to either fight or flight or there’s free state, which is a parasympathetic autonomic nervous state, which is that more healing state. But the activation of a certain part of your vagus nerve keeps you in a freeze state, which is actually an abnormal state.

Dr. Jessica Drummond (00:29:06) – So imagine you just got in a car accident or something, and you have a broken arm, and it’s really painful, but you can’t get out of that car. You have to wait for someone to get you out. Something’s on your arm or something like that. You’re not dying, but you’re in intense discomfort. Your body is going to stop and put you in kind of a frozen state, so you can tolerate that for however long you have to sit there. And that’s one of the reasons why work is a bit of a blessing and a curse. Like it might keep you in sort of a frozen enough state that you can shut down some of the symptoms in your nervous system, some of the sensation of the symptoms, but it’s also maladaptive. And you’re not healing in that state. So freeze state you’ll know it by like can’t motivate. Higher low energy, too anxious to do anything. You’re kind of stuck, depressed sometimes. So when you’re having those mood swings that could be in the Free State, and then there’s ventral vagus activation, which is what we really want.

Dr. Jessica Drummond (00:30:12) – That’s the calm state of aliveness. So you feel there and awake and alert and engaged and relaxed. That’s the healing state. So you can be completely at rest. You can be interacting with people and feeling relaxed. But that’s a challenging state for most people to get into these days. And then between jobs and pandemics and terrible news cycles and social media doomscrolling, and then you layer on just having had a surgery after a decade long chronic illness, practicing staying in ventral vagus, calm aliveness. That healthy parasympathetic state takes a lot of work. So as you said, you know, acupuncture, yoga, breathwork, you know, nature, movement, tapping, being mindful of how other interventions knock you out of that ventral state, for example, being on hormonal suppression like birth control or Lupron or LSA. So noticing that is step one and then finding the tools that work for you. And like I said, when you do all of these things, we do homeopathy. We do just exposure to nature, slow walking, Pilates, you know, there’s movement ways.

Dr. Jessica Drummond (00:31:32) – There’s hugs, petting your dog.

Federica Torri (00:31:36) – Hugs are great.

Dr. Jessica Drummond (00:31:38) – Yeah. Sometimes it’s oxytocin, you know, replacement therapy if you will. So there’s lots of things that we can do even directly. Like you can literally shoot oxytocin up your nose if you need to. There’s nasal sprays. There’s two doses. I didn’t know that okay.

Federica Torri (00:31:54) – That’s.

Dr. Jessica Drummond (00:31:56) – Yeah. So there’s things you can dissolve in your mouth that gives you oxytocin. But you can also get it from hugs and connection and dogs and cats and guinea pigs and whatever. So I think that what’s really valuable is you’ve discovered a lot of those tools and you’re actively using them. One thing that’s important to remind everybody is that you can know a thousand tools intellectually, but if you choose just one and do it most days, that’s going to be better.

Federica Torri (00:32:27) – Yeah. No, it’s so true. It’s so true. Before the surgery, when I was very anxious about it and like I was trying to do everything because I was like, oh my God. And I was like, come on, you’re a scientist.

Federica Torri (00:32:39) – You know that if we change all variables, then we can’t see what was that worked. And so then I was like, okay, so now I’m using more of it. Like, okay. Yeah. Because as my yoga teacher says, sometimes more is not better. It’s just more. So I’m trying to just say good perspective.

Dr. Jessica Drummond (00:32:57) – All right. So your nervous system, which is kind of where we start. So we have a seven step system in our mindset. Strategy is like where we start is getting everything regulated because nothing else works as well unless we’re in that state as often as we can, knowing we’re going to fall out of it several times every day. And that’s fine. The key is just keep coming back there. Then the next step is we want to see what is your real goal. So there are some certain key priorities, areas of discomfort. But if you could imagine your life in a year from now, six months from now, or whatever time frame you want to give it, what would your vision and goals be?

Federica Torri (00:33:35) – Yeah, I think or I feel is better to say, not being in constant fear of what the day is going to bring, because my life now has very good days, but I have so much grief for all the life that I in a way, loss and all the suffering, that it’s enough that I wake up and I don’t go to the bathroom well, and I start feeling my nerve pain and all of that, that I really, as you said, I really shift very, very, very fast to this pool of sadness.

Federica Torri (00:34:09) – That’s not dangerous, per se. I’m not saying, oh, no, I mean, I’m going to jump the window or anything. It’s just that it really takes a big tall. I don’t believe that my goal would be to see myself like, always, like happy with no problems, just trusting this body. Especially after all of this, after all the validation that the disease was there. Definitely. I’m having more compassion for my body, but especially because I have desired and I don’t feel myself even like the libido side of thing. I don’t feel my body, and so I’m trying to see if I can regain that feeling, not dissociated and feeling in. And maybe it’s different than before. I mean, I don’t think it serves me to say I want to feel exactly how I was feeling when I was 19, but I think not in pain waking up and say, oh, I have all energy to face my day and feeling good in my body, just like, oh, you’re cute this morning kind of thing.

Dr. Jessica Drummond (00:35:07) – Yeah. That’s beautiful. And I think it’s really important that we address that fear and grief piece, because again, when your surgical team says to you, you’re going to be ready to go in eight weeks, you can do Pilates, you can run, you can do whatever you want. But if you have been with something, managing something, navigating something for 12 years, and it was really hard and it took a toll on you and it was exhausting and exhausted your family and friends, and you also lost that time. So how old are you now? Do you mind sharing with us?

Federica Torri (00:35:44) – No, no, I’m 41, 41.

Dr. Jessica Drummond (00:35:45) – So 19. You felt great. 41 you’re starting to come back to yourself. That’s two decades that you kind of missed. And we should be creating space for you to heal and grieve, you know? I mean, I feel the same way you missed years of your life when you live in these chronic illness states and you didn’t totally miss it. You know, you’ve had some great work experiences, you’ve got a great partner, you’ve got things in your life that are great.

Dr. Jessica Drummond (00:36:17) – So I think we always have to be comfortable with the fact that grief and things being great can be in the same two hands at the same time.

Federica Torri (00:36:25) – It’s so true, especially because of my training as scientific training and also plus like my personality I grab is either or. And the biggest teaching for me actually. And we are so aligned today it’s exactly this. And it’s like, oh, things are going better. And I still have pain. And in my mind two things couldn’t be because after the surgery, in a way, if the surgery worked then I should be feeling okay. And actually no, it’s an end. So it’s I think for everyone listening this end piece, I hope it resonate because it’s a very, very key.

Dr. Jessica Drummond (00:37:02) – Yeah. So you’re on the upward spiral of healing, which means that you’re having more, better days and some days maybe around ovulation, maybe when you have a rough who knows what you ate the day before or what stresses you were under the day before or whatever, that you have a little rough morning bowel movement that you can quickly shift into fear and grief.

Dr. Jessica Drummond (00:37:26) – And what’s one of the words is known in this kind of pain? Science is catastrophizing, where you start thinking this is going to be forever. And that’s a normal response because those pathways are well traveled in your brain for you to be like, oh no, this is forever. And then your mood gets all over where as you can say, you know what? This is literally right? Right now I’m in discomfort, but this bowel movement is going to pass in a few minutes and then I have the capacity to feel better. Maybe it’s two points less pain, maybe it’s ten points less pain. We won’t know until then. So that slowing down of the healing and knowing that it is very variable for these first several months for sure, I hope feels helpful for you.

Federica Torri (00:38:17) – Now it is. And when we were talking, was the one thing that I hope is useful for other people to using the support groups after and before surgery can be useful, but in my personal experience, it put a kind of gold standard or baseline that I would subconsciously measure in.

Federica Torri (00:38:34) – My healing towards. There are women. There are people that after surgery they don’t have any symptoms anymore. And God bless them, I’m truly happy for them. But there are so many pain generators that that cannot be the definition of success, because it’s not the experience that everyone. So yeah.

Dr. Jessica Drummond (00:38:56) – Yeah, that’s really valuable. You know, I’ve been in this field for almost 25 years now, and because I never see the people that bounce right back after surgery, in my experience it’s much more always like this. So it’s a wide range of responses. You know, you could have someone who’s 19, who hasn’t had a lot of symptoms yet, who have a less severe situation, and just taking the out of foot quickly, taking that endometriosis out quickly. The body recovers more quickly on its own and that happens. So I also want to put that potential out there because for some people and hey, you could even be 40 and that could happen for you. That does sometimes happen and it’s not a bad thing.

Dr. Jessica Drummond (00:39:42) – And it doesn’t mean the surgery wasn’t a success. If you still have work to do after. And it’s part of, I think, the journey of life, you know, having lived with a chronic illness now, I really feel like part of the teaching of life is that we all have immense challenges of varying measure, you know, not just living with the chronic illness, but just being almost 50 years old. It’s like, I don’t know a single person personally.

Federica Torri (00:40:08) – That’s like waking up every day. I’m feeling like, oh, I’m Fiji, I’m Fiji again.

Dr. Jessica Drummond (00:40:14) – You know? And I know people who have moved to like Bali and it doesn’t matter. Like you can’t escape it. This is life. Like you could live in the perfect place and still have stress and pain and chronic illness and all of that. So the benefit is it’s like once you’ve come through the surgery, now what we start looking at, okay, your vision is that you have more energy, that you wake up feeling good most of the time that you can start re-engaging in life, choosing more with more focus or more discernment.

Dr. Jessica Drummond (00:40:47) – Your next level career, your next step career. You know, continuing to have a lot more fun with your partner and your friends and your family. And this is a great vision. And we do in coaching, we lead with that. So, you know, if I was working with you for months, we would spend a whole day just like building a vision board, building a vision journal. Like really see that because it’s important to not just be running away from pain, but to be going towards something amazing and also having that thing right now. So today you’re feeling however you’re feeling, and you’re showing up here and doing some really skillful advocacy for absolutely anyone who listens to this podcast, which may be a part of the next step of your career journey, for example. Well, and so the other thing I was going to say is, and in that moment, you can also have a little more fun every day by like dressing a certain way or going to a museum. However you feel like you can have this in little bites too.

Dr. Jessica Drummond (00:41:54) – It’s not all or nothing.

Federica Torri (00:41:57) – Yeah, no 100%. Now that I am where I am right now, I feel I don’t want to do the positive psychology read on the journey because I honestly, as a receiver of that, when I was in the midst of it saying, oh, think positive, everything happens for a reason. It can be very triggering. What I’m going to say is that this pivot I had to make is one of the most meaningful things that has ever happened to me, because it kind of made me wake up to the fact that I am born to serve something with my passion that is closer to people’s life if I want and if I wanted, I can go through the corporate ladder, make tons of money that I’m going to have to spend in tons of therapy. Because in the end, I love the people I work with. But standing up for The Invisibles, for example, has become a huge mission for me. I’m looking at advocacy position in different fields, and I’m also, after one year home, I started having like flowery business dresses and maybe I tried to to like have my routine in the morning.

Federica Torri (00:43:01) – It doesn’t always work. Some days I just feel not good, but I feel in my body more when I take care of myself, that’s for sure.

Dr. Jessica Drummond (00:43:10) – Yeah, and I agree with you. It’s not always this triumphant story of coming through, and it was the best thing that ever happened to me. I absolutely don’t think my chronic illness was the best thing that ever happened to me. I still think it’s the worst thing that ever happened to me. And we can gather meaning, which is valuable, and we can gather sort of a sense of strength within. Ourselves. And you know, all stories have some level of inspiration, no matter how challenging they were. So I agree with you. I think it’s very important to not be like, this is great. No, this also sucks. And that’s okay.

Federica Torri (00:43:53) – Yeah. I mean, there are some I don’t know, especially on social media. There’s sometimes some very cheap, positive psychology that is not very rooted in how really the psychology of a person that’s suffering and has chronic pain works.

Federica Torri (00:44:06) – So I’m trying to stay away from that. But it’s true. It can bring meaning.

Dr. Jessica Drummond (00:44:10) – Beautiful. Okay. So we have a clear meaning. We have a clear vision. And part of that is about improving your symptoms. So let’s get into the physiology of the next levels of the systems. So the nervous system is then connected to the digestive and immune systems, which are very connected to each other about 80% of our immune system is kind of wrapped in and around the digestive system. And for you, you’ve had a lot of endometriosis related bloating, constipation, bowel pain, constipation, diarrhea, swings, that kind of thing, abdominal discomfort, and a lot of food sensitivities. So one of the things that has evolved in my practice, even since I wrote Outsmart Endometriosis, published about four years ago, is we used to do a lot more with elimination type diets to try to take away the foods that are causing irritation to the immune system. The problem with that is if you do that too aggressively, you make the nervous system afraid of foods unnecessarily.

Dr. Jessica Drummond (00:45:21) – And so I take a much lighter handed approach. And I think that is kind of the direction in which you’re going now in terms of your food journey. Can you share that with us just a little bit now?

Federica Torri (00:45:32) – Yeah. Yeah, absolutely. So my journey really reflects what you are talking about, because in the past I’ve been working with dietitians for IBS when I didn’t know what I had. And it really helped me because at some point I was scared. I mean, I have a background of eating disorder when I was very young. So for me, the concept of diet is very triggering. But also since I was having all these symptoms, I was eating for food. So through working with the nutritionist, I got back to eating more foods. But my symptoms have been very erratic. So even when I was journaling and trying to find a culprit, it could really be that I ate the same thing. I was just sad. One day I was scared another day or I was dancing. So what I’m doing now, I’ve been reading tons and tons.

Federica Torri (00:46:19) – So thanks to the classes in your courses, because I graduated as an endo coach and so I really studied a lot, I really try to be very experiential. And if you talk to me about my diet, it’s already very clean. So I don’t drink no caffeine. So like intuitively already I’ve never had and I don’t have any desire of inflammatory foods per se. I am eating very little gluten, and I tried also to be completely gluten free. And actually for my system, every single time I get super constipated. And it’s probably because gluten free products can be maybe more refined. I eat very little meat. I tried also to be fully vegan, but for my body it doesn’t work. So once a week meat. Tons of veggies. I finally have been very courageous and reintroduce cruciferous that I was very scared of, but actually and also lentils and beans. So I’m in the process of really, I don’t want to put a goal around it. I’m not doing this because I want to become vegan in six months, but I am trying to explore sources of proteins that don’t come only from meat.

Federica Torri (00:47:25) – And fish is very good for me. And I cut sugar completely. Sugar for me, not the sugar in fruit, but any other refined sugar really like sends me to trigger and become six months pregnant. Bloated, yeah.

Dr. Jessica Drummond (00:47:40) – Bloating. Yeah. So in step three of our system, we take your story into account with equal weight to any lab testing we have, any wearable data we have. So whether it’s your Fitbit that showed you how to rest more, how to sleep more, how your recovery timeline is when you need to take breaks and you can do that with other garments or earrings, apple watches, whatever you have. And then you have done for lab tests in the recent past. So one of them was an ECG food sensitivity test. And I want to talk about this a little bit. There’s a little bit of data that shows that doing an ECG food sensitivity test is a useful guideline for an elimination diet that will give kind of the digestive and immune system a chance to rest and let.

Dr. Jessica Drummond (00:48:33) – The immune system be less overreactive to things it shouldn’t be reactive to, which is essentially any food. Now, the problem with the food in the US more than in Italy, which is kind of interesting, is that we have more glyphosate, more chemicals, more processing. So sometimes eating foods in parts of Europe is less chemical laden than it is in the United States. And so that could be a piece of the puzzle and this particular case for sure. But there are also some foods that popped up as positive on your testing. Alfalfa. Oddly enough, garlic. You know, there are these occasional ones. Garlic is a common trigger for bloating, you know, Sibo type things, and so is endo, which we’ll get into in a minute. So I don’t do IgG food sensitivity testing most of the time in our work, because what I find is that it just makes people afraid of things. But sometimes it can be valuable because you can say, okay, there’s just a couple things on here that are really lit up.

Dr. Jessica Drummond (00:49:34) – Let’s give your system a break. And there is also some data that doing about three days of fasting, which I wouldn’t do right off the bat, I would help people build up to that with like intermittent fasting and maybe one day a week fasting for a little while, or one day a month or one day a quarter. And eventually three days can help the immune system stop overreacting to regular things like foods that it shouldn’t be reacting to foods, dusts, environmental allergens, pet hair, stuff like that. So one of the reasons we do a short term elimination is to quiet down the immune system. So for you, it sounds like that was somewhat helpful. But the bigger thing was to not reactivate an eating disorder, which is essential, and to start getting your nervous system comfortable with expanding your foods. It’s okay if you’re a little bloated for a little while. You know, just starting getting comfortable. Because when you heal your gut, there is a period of transition where sometimes you’re going to go through some of that more bloating.

Dr. Jessica Drummond (00:50:41) – We just need to keep it manageable for whatever that feels like for you. Does that make sense?

Federica Torri (00:50:46) – Yeah it does. It does. Absolutely.

Dr. Jessica Drummond (00:50:48) – So that’s one thing. So that’s one lab test that can guide things. And then the other from the gut standpoint that we have here is Genova GI effects. This test a GI is a stool gut microbiome test. And the gut microbiome is such a key indicator in there’s a gut brain axis. So mood swings can come from bad balance of good and bad gut bacteria. Immune system is driven by the gut microbiome and your digestive processes. So this stool test was done to look at the gut microbiome was done before her surgery. But let’s still take a look at some of the impacts. So challenges with breaking down in protein and fats. So with her digestive enzymes increased inflammation. So increased secretory IGA which is part of the immune system that lines the large intestine gets really activated and inflamed. Not too bad. She’s at a four out of ten. And with ten being the worst in that circumstance she’s a ten out of ten for dysbiosis, which is a balance.

Dr. Jessica Drummond (00:52:00) – So we’ve all heard of the gut microbiome inside of our mostly our large intestine, but a little bit in the small intestine. There should be a whole huge colony of microbes fungi, parasites, viruses, bacteria. We don’t even know everything that’s in there that’s supportive unless there’s too many that are more pathogenic, more problematic, and not enough of the beneficial ones. So it’s about balance, and it’s about where the gut microbiome is in the intestine. It should be mostly in the large intestine. For a lot of people with endo, it kind of creeps back into the small intestine. And we’ll get into that in a second. That’s where you get quote unquote endo belly or Sibo cf0. You know, any of those acronyms small intestinal, bacterial or fungal overgrowth. And her bacterial overgrowth in the stool is not great. Really high yeast Sibo which is positive for Sibo. Her immune system is being somewhat suppressed because she doesn’t have that really healthy, robust, beneficial bacteria, not really resilient beneficial bacteria. Her digestive enzymes are a bit low, which is why she’s having trouble breaking down fats and proteins.

Dr. Jessica Drummond (00:53:24) – Inflammation in the lining of the large intestine. Low, short chain fatty acids, which is the short chain fatty acids, are the. It’s the things that the good bacteria create that help feed and heal the lining of the large intestine. So she’s really low on that, including butyrate, which is one of those key short term fatty acids which feed the monocytes or the cells that line the large intestine. And then beta glucan is pretty good. That’s good. Sometimes that’s elevated, which will keep recycling estrogen for people with estrogen dominance. She’s not dealing with that. But what she’s really dealing with is a not great composition of the bacteria in her large and small intestine, which is going to be problematic for both metabolism and not really infection per se, but an imbalance in the immune system’s ability to fight things. So when the immune system gets constantly flared up and active against regular things like food and dust and dog hair, then you’re always active, active, active and not targeted. So if she gets some kind of bug, like a stomach bug or a viral infection, it’s going to be harder for our immune system to get really focused and targeted and fight that off, because there’s always this like cloud of inflammation.

Dr. Jessica Drummond (00:54:51) – And that’s where we’re going. Or have you noticed anything like that in your life?

Federica Torri (00:54:55) – Yes, I noticed that last year when my symptoms became worse and so my inflammation became much worse, especially when they put me on a mix of estrogen and progesterone. I was breaking out like I never break out. I was breaking out on my skin. I was very inflamed in my bowel movement. My stomach was constantly inflamed, and I kept on getting sick. Like, I am really not a person that gets sick with respiratory bugs, and that last year I got sick every single month. So I definitely noticed that when things got bad, my immune system was not there for me as it has always been, that’s for sure.

Dr. Jessica Drummond (00:55:38) – Yeah, so it’s overactive in some ways and underactive in some ways. So that’s why we have to bring it back and balance. Now, one thing I want to quickly say about the endometriosis impact on the intestines. So many people have this bloating that you talked about. So there’s only two ways for this bad bacteria to get into the small intestine.

Dr. Jessica Drummond (00:55:59) – One is that when we eat food, it’s not sterile, right? I mean, we don’t like run our food through some kind of autoclave before we eat it. So we have to have good stomach acid to kill off the microbes that shouldn’t be coming in, hitching a ride on our food. A lot of people, because they might have had heartburn for a long time or whatever, could have been on proton pump inhibitors, drugs or other acid reducing drugs, anything like that in your past?

Federica Torri (00:56:27) – No, I have to say that after the surgery, since I was taking loads of anti-inflammatories, they gave me a low dose to protect the stomach. And I have to say that I’m experiencing once a week some heartburn and that I never had before. And even I tried to use digestive enzymes and they give me a terrible heartburn. So this is new, and it’s the only time in my life that I used a proton inhibitor.

Dr. Jessica Drummond (00:56:55) – So we may need to start restoring good acid in the stomach, which will also better activate the enzymes that break down proteins, because right now you’re eating some animal protein, which is good for healing because we need some of those amino acids.

Dr. Jessica Drummond (00:57:11) – But you’re probably not breaking them down very efficiently. So they sit in the stomach and kind of ferment and you end up with like bloating and gas. And they also just aren’t broken down very well. And so they can then bring because there’s not enough acidity in the stomach, those bad microbes into the small intestine. So that’s one thing that happens. And then the second thing that happens in endo is if you have endo on or around any of the intestines, which sounds like you did, even if it wasn’t fully, deeply infiltrating, you still get areas. If you think about the intestine, we want this nice smooth peristalsis going consistently through yours is like patchy. And most people with endo have little pockets somewhere where things aren’t moving as they should. And so that’s another area where it’s warm and slow and full of food. So bad bugs can grow. Yeast in particular. And there’s a little valve between the small large intestine called the ilio cycle valve that, like I said, there’s supposed to be a ton of really beneficial bacteria and some not so great bacteria in the large intestine.

Dr. Jessica Drummond (00:58:20) – But if that door is stuck open or kinked a little from an endo adhesion or a post-surgical scar or anything like that, or just an endo lesion, that door can allow for the bad bacteria. To then, or even the good bacteria in the wrong place, scootch up into the small intestine. And so that’s why people feel so bloated. So with endometriosis, it’s not so much that we just eradicate Sibo and CFO and bloating with like one course of antibiotics or one course of antimicrobial herbs. It’s that we manage the Sibo or Cf0 with improving the stomach acid, which also can be benefited by mindful eating, chewing, slowing down when we eat, not eating, standing up in the car. You know, all of that, which again, I know you and everyone else listening to this can’t do that all the time, but more of the time. And then adding some stomach acid and digestive enzymes support in a way that’s going to help with not cause more heartburn. And it makes short term cause a little bit of heartburn.

Dr. Jessica Drummond (00:59:26) – But we want to do it in collaboration with Visceral Physical Therapy, which is a manual skills to help make sure your diet is moving well. You know, just your chest area, your stomach, your small and large intestine, that ileus cycle valve. Because in that fascia is where some of that nervous system upregulation can happen when things get sticky, and then the immune system gets hyper activated and food is not moving through. And so the microbiome reacts negatively. So we use supplements for stomach acid, digestive enzymes, gut motility and then pre and probiotics. Once all of that is moving better. But we can’t start with any of this stuff until we’ve opened the windows and doors. And I know you’ve heard me say that before. Yes I love it.

Federica Torri (01:00:23) – It works very well.

Dr. Jessica Drummond (01:00:25) – Yeah. So one of the reasons why you probably got so activated with adding hormones is that your body was not able to metabolize them. Well, we never want to add hormones, even perimenopausal hormone replacement therapy or menopausal hormone replacement therapy without making sure that the lymph is flowing well.

Dr. Jessica Drummond (01:00:49) – So the lymph is like your superficial circulatory system, which is very gentle and light, and it’s kind of integrated in the fascia. And it’s a system of moving fluid through the body. But it doesn’t have pumps like the circulatory system doesn’t have the heart. So it’s pumped by physical movement, you know, and all kinds of movement, rotational movement, full range of movement, flexibility, stability, strengthening mobility and gentle massage. Kinds of techniques. Gua sha, lymph drainage, massage. There’s many, many ways to get it moving. But in most people with complex chronic illness, your lymph is sluggish. So we got to start there. And then we have to get the bowel moving because again, you can’t process the estrogen if it keeps getting recycled in the large intestine. So if you’re having chronic, even mild constipation, I like to see my people who’ve been dealing with this level of sluggishness and toxicity, having great bowel movements at least 2 or 3 times a day, like 1 to 3 times a day, is what we’re looking for.

Dr. Jessica Drummond (01:01:58) – And for most people that take some work, we’ve got to optimize a lot of different things magnesium and everything else. How about you? What have you found to help that for you?

Federica Torri (01:02:08) – Yeah. So the thing with me is that I am a one or twice bowel movement person per day. So people are like, you’re not constipated but actually is a functional constipation. I had to build an entire ritual around bowel movements. Now where I know that I’m going to be in child pose on the bathroom floor and then it never gets out all at the same time, and it’s more functional. In my case, it’s the organ that doesn’t sphincters. They don’t coordinate. Always very magnesium is absolutely foundational. Like I always have magnesium at night before bed and it changes my life. I also, in cycles, take a motility supplement that contains three phyla and then other generations. I don’t take it all the time because I don’t want to get to use to it, but it unblocks the situation for me. And then I also notice vitamin D when I have good vitamin D and vitamin B as well.

Federica Torri (01:03:05) – For me, vitamin B12 especially, I noticed that I can go my omega like I’ve always seen lots of improvement in how I feel when I take omega threes. Fish oil. I mean, sometimes it gives me like especially lately, heartburn. So that’s a supplementation that I’m not successful at keeping on taking constantly. But this is more or less my regimen than in the morning. I take a thing called adrenal cocktail that contains its. To recharge the ability of creating ATP and energy, but actually helps me with my bowels very much so that’s my personal regime that I use.

Dr. Jessica Drummond (01:03:43) – Yeah, and that makes a lot of sense, right? Because it’s hard to make vitamin B12 if your stomach isn’t acidic enough. Vitamin D is difficult for everyone to keep it optimal levels, and it does help with that circadian rhythm. So I always say the bowel and the brain like rhythm. So those morning routines, some manual therapies for the motility. We might need to use some antimicrobials in your case because there is some strong data that killing off the yeast and bad bacteria.

Dr. Jessica Drummond (01:04:10) – But then we’ve got to kind of get it out. So we don’t do that until you’re at least having decent bowel movements. As you said, magnesium. We also sometimes use supplemental tools to support the vagus nerve, to kind of have that morning stimulation that supports acetylcholine. There’s a product called Pearson Plus there’s the motility supplements. So there’s lots of different tools and you’re using a lot of those I think we would review that regiment. But overall that’s good lymph support, bowel support and then liver support. And again we can use specific supplements for the liver. Everything from milk thistle to castor oil packs also helpful for bowel movements. You know visceral massages to the liver. There are lots of homeopathic for the liver. That’s really how I support liver is just making sure things are moving breathwork making sure. And again, with endo, a lot of times people’s breathing is off. Their rib cage isn’t moving well. There’s not good rotation. People can have endo on the diaphragm, in the lungs, on the liver.

Dr. Jessica Drummond (01:05:18) – So that liver support can mean a lot of different things. Do you have enough amino acids to support the liver? Do we have enough acetylcysteine, which has some great data on it behind for endo taking it recently? That’s a really good pre and post op supplement too, because it helps stabilize any growth of new lesions or growth of the lesions. So those three things lymph bowel, liver. And I also think about sweating and exhalation. That kind of day to day detox. Do you do anything for that.

Federica Torri (01:05:50) – So that’s my goal. I definitely move and exercise every day and also my yoga practice sometimes. It’s definitely pretty active. I haven’t been able to go back to my aerobic regime because many times I’m so fatigued and I love dancing, and there is a class that it’s my goal to go back in February. So this month. But it’s one hour of like music super loud and go, go go go go. And many times I don’t go because I don’t have it in me. And so I’m trying now every couple of days to do ten minutes of he has videos available.

Federica Torri (01:06:24) – So bringing aerobic back, that’s the part that I think I miss the most. I mean, I realize especially I mean taking your classes to that. Yes. It was good for me a couple of years ago when I was going like three times a week, but also was very stressful for my system. And so it’s finding a good balance there.

Dr. Jessica Drummond (01:06:46) – Yeah, for sure. And I think that that’s one example too, of living the vision in the bite size amount that you can do now that’s perfect. So that’s really fun. Again, sweat movement. And we have to be mindful of course of what you just said the adrenals. So that brings us to and so some of the things you’re intuitively doing with your diet. So it’s generally clean which is good. Caffeine, alcohol sometimes caffeine is beneficial for people with endo because it kind of gets the morning rhythm going. I don’t over under emphasize it. It just kind of depends on where, you know, people who love their coffee fine. One cup of coffee at the same time every day can be valuable.

Dr. Jessica Drummond (01:07:26) – People who don’t care and feel better without it also fine. And so we get that morning rhythm going. And now you’re talking about, you know, eating fish for protein, which again is going to be harder. Fish and meat are great sources of protein. Most bioavailable eggs too. But they have to be able to be broken down by the stomach, which is hard when we have by the digestive enzymes. So we need enough acidity, we need enough digestive enzymes, which are situation is low in, but we can’t just throw all of that at it. We have to be gentle to it. We have to create the space. We have to make sure there’s good lymph and movement and all of that. So you’re on the path. And what nourishes the butyrate producing bacteria, which we want. So we want to kill off some, which I like to do with a pulsed herbal strategy. So we use pulsed antimicrobial herbs every couple of weeks to, you know, we might do it for three months as a loading dose and then maybe once a quarter or once a month or for a few weeks on, a few weeks off.

Dr. Jessica Drummond (01:08:27) – Just depends, you know, given however that person’s body responds and how well we’re. Doing all of the other things. And once we start that, I also like to layer in pre and probiotic foods, which intuitively, you’re starting to do more of anyway. More lentils, more cooked cruciferous broths to help the lining of the intestine glutamine, zinc. So there’s lots of tools we can use to really nourish that digestive tract. And I like to do as much of that with slowly adding good things to the diet. So the diet feels much more delicious and expansive and flexible and all of that. So great news on the digestive front. Now shifting gears to the hormones, which are still related. As you said, if you’re exhausted in the morning or you have way too much estrogen or way too much progesterone, the gut is also going to slow down. So we always support the hormone system by supporting the hypothalamus pituitary adrenal axis, the HPA axis. So on your Dutch test here, your HPA axis, when you wake up your cortisol is super low.

Dr. Jessica Drummond (01:09:46) – So of course you feel exhausted. We want that ideally to be in kind of the top third of the range. So you wake up with that little morning burst of cortisol. If you need it from your coffee, you’re probably not getting it from your hormones. So we think about brain inflammation. We think about rhythm, we think about sleep quality, and we think about adrenal supports. And there’s adrenal support herbs. There’s vitamin C, there’s optimizing salt balance. Another thing that’s very common for people with endometriosis is to struggle with a trifecta of mast cell activation. So you’re a little sensitive to a lot of things that that’s that immune overactivity and hypermobility and disorder anemia. So we have to be careful with yoga of overstretching joints instead of muscles. And we have to be careful of our blood pressure can be a little bit all over the place. Our like reactivity can be a little bit off in terms of those autonomic issues. So that’s probably why in the morning you feel better with what’s known kind of on TikTok and on social media is the adrenal cocktail.

Dr. Jessica Drummond (01:11:01) – So the adrenal cocktail is essentially vitamin C, which supports the adrenal function with salt and fluid. And that can, you know, be water. It can be juice, something that tastes good. But the reason we do that is because that salt water in the morning gets you rehydrated in a way that helps maintain the autonomic function. So that should continue to help. How do you feel in the morning when you do that?

Federica Torri (01:11:28) – I mean, I’m not going to say I get the kick if I get caffeine, okay, but I feel more energetic when I exercise. So it took a while because the first few weeks I could really feel my bowels like, like gargling all the time. I just feel it makes things move instead of feeling sluggish. I feel my bowels are making those little noises, so it makes me feel definitely better. Is it every day? No. But overall as a trend I notice a difference.

Dr. Jessica Drummond (01:11:58) – So that’s really good. And then we can use some adrenal support. Adaptogen. So those are herbs that help kind of modulate our energy.

Dr. Jessica Drummond (01:12:07) – And we can use things that support the mitochondria. That’s things like CoQ10 PQ, the Acetylcysteine and the glutathione to help with gentle detox for the whole system. So it’s not over strained. There are other micronutrients that support the mitochondrial function like certain B vitamins nicotinamide, mono nucleotide and then all of the antioxidants, which are those colorful things in fruits and vegetables. What makes fruits and vegetables colorful things like resveratrol and lutein and all of that that we mostly want to get from food. But, you know, in some cases we do need supplementation support. So mitochondrial support, adrenal support. So your morning adrenals are tanked. But the good news is the cortisol curve increases normally with kind of the morning wake up and get moving. So you are kind of feeling more restored a few hours in and then it falls off a cliff again around dinnertime. Dad, we’re like, oh, somebody made me food. Which again, this test was done pre-op, but still, it might be even more tired now. So when your cortisol is down, you’re going to feel tired.

Dr. Jessica Drummond (01:13:28) – So that’s when we build in some support network for what’s your web of support? Around getting someone to help with dinnertime meal prep or that kind of thing.

Federica Torri (01:13:39) – Yeah, I’m very lucky. In our home, roasts are not attached to gender, so even if I’m from Italy, I’m not the one that loves to cook here. So I definitely have a great support system when I am exhausted at night. And very lucky about that.

Dr. Jessica Drummond (01:13:56) – Good, good. That’s really important. And then it does perk up a little bit right before bed, but not so so high that you can’t fall asleep. We definitely want to dive into sleep, but I want to slowly start wrapping up just because, you know, we’ve gone on for a while and then we’ll continue as needed after this. So in the hormone piece of the step four, where we’re kind of pulling in the data. So step three we’re looking at all the data. Step four we’re thinking about next step. And step five we put it into a schedule.

Dr. Jessica Drummond (01:14:25) – So you can actually start doing these things relatively consistently. And with your scientific mind begin to execute and see how your body is responding to not too many changes at once. So we’re also seeing relatively normal progesterone at this point. And you have the IUD, low estrogen, which can be kind of okay in the short term given the we’re trying to recover from endo. But I can understand why your libido maybe all over the place, why your mood is a bit all over the place. You know, there’s a lot contributing to that regarding estrogen modulation of metabolism in the brain, so that it can also put you in a kind of short term premenopausal state, which makes your libido go down, which makes your metabolism your insulin resistance a bit higher, which can make you gain weight. And so the IUD is a good short term solution for kind of mitigating or minimizing any new endometriosis post-op. But it’s just kind of a way to stabilize the system for the short term from too much fluctuation. But it may not be a good long term strategy.

Dr. Jessica Drummond (01:15:35) – One thing we didn’t talk about in your case is fertility. Do you have any particular fertility goals? No. Okay.

Federica Torri (01:15:43) – So on that. I’m happy that I feel this way because I’m not concerned about that.

Dr. Jessica Drummond (01:15:48) – Okay. And again, that’s something if you’re listening for our clients to take into consideration because in that case, we want to do excision surgery as soon as possible to more optimize fertility options. But also that first year post-op, there is some good data that shows that some of the immune markers drop off, which make it more successful in terms of fertility optimization. And so if women are in relatively younger, having early excision with all of this work done really aggressively around that pre and post op timeframe, which you know, could take a year or two years, it can happen within that. But that’s when we get a little help from the system, dropping the immune hyper reactivity, which can cause infertility as well. So overall I think from a hormone standpoint, since you reacted so poorly to taking a hormone, my goal for you and with you would be to eventually help.

Dr. Jessica Drummond (01:16:46) – You no longer need the IUD, but we want to make sure those windows and doors are really open and moving, and that you’re nourished enough because you’re only 41. Your body should be able to make all these hormones. You still have your ovaries, you still have your uterus. But there has been a lot of like physiologic trauma to them between the scarring and the surgery and all of that. So we use everything from peptide bio regulators, which help kind of nourish the organs, to just making sure your body is absorbing amino acid. So you’re getting enough protein from any number of sources that your digestion is working kind of your root cause I would say at the moment is that intersection between the digestion, immune and nervous systems. Does that make sense? Yeah, no it does.

Federica Torri (01:17:37) – It’s definitely the hotter spot for me at the moment.

Dr. Jessica Drummond (01:17:42) – Yeah. All right. So let’s come up with a quick kind of first step plan that you can do in your day. So given everything that you’ve said you’ve got this supportive environment.

Dr. Jessica Drummond (01:17:54) – You have a little more time and space to heal. And it’s so pivotal that you’re nourishing your immune nervous system and your whole body nervous system, not just your brain and your digestion. So we wake up in the morning, we’re a little tired. What feels like the first good thing for you to do and some options. If I’m putting my coaching education hat on, step outside with a warm glass of electrolyte water. Your adrenal cocktail, do some journaling. Do some morning movement. Have a cup of tea with maybe light caffeine to get your bowels moving. Take a walk so there’s lots of options. What feels like a good. Start for you.

Federica Torri (01:18:34) – For me, I think waking up and making the adrenal cocktail drink some of it, and then going out within the first half an hour that I am to have a little, even if it’s 15 minutes. But walking does wonders and then coming in for at least a 15 minutes exercise. It can be anything. If I am very tired, it can be like fascia flossing, stretching, or can be a yoga session or can be some dancing.

Federica Torri (01:19:02) – But definitely within the first hour that I am awake moving. If I don’t move, it’s guaranteed I become very like.

Dr. Jessica Drummond (01:19:12) – Yeah, so that’s beautiful. So you’ve got your movement, you’ve got nature, you’ve got sunlight, which resets the circadian rhythm and keeps that nervous system rhythm moving. You have a little adrenal nourishment in the morning. Then I would recommend relatively early because of your HPA axis weakness that we start supporting your digestion with either betaine HDL, some more direct stomach acid support, or apple cider vinegar. That’s diluted. Good chewing, good mindful eating, and your largest meal being breakfast. So I like to say to my clients, you know, dinner for breakfast rather than breakfast for dinner. So that’s when you have your largest protein heavy meal. And we can do more of the targeted supplementation, digestive enzymes, maybe some probiotics, prebiotics, prebiotic and probiotic food for sure. Protein possibly those peptide by our regulators and some pre and probiotic fibers. So vegetables whole grains beans you know and these can be rotated recipes that we can support.

Dr. Jessica Drummond (01:20:20) – So I think you know we’ll start there with a morning routine focusing on the digestion the bowel function nervous system settling. And then often what I’ll do is layer in more things through the day as we go. How does that feel for you.

Federica Torri (01:20:37) – Know, it sounds great.

Dr. Jessica Drummond (01:20:39) – Okay, great.

Federica Torri (01:20:40) – It feels feasible to. So that’s also an added.

Dr. Jessica Drummond (01:20:43) – Yeah. And the other thing is you’re in this visioning moment too, where you’re starting to think about what your next job will be in the next six months to a year, so it can help you design what kind of schedule you need for the job to fit into, rather than trying to fit your life into your work schedule. Okay, so we’ve got that scheduling. And then the last two pieces are one is the support network to make it happen. And we’ve talked about that in your case a little bit. So everyone think about you know who’s making you dinner. What might you have to change financially. One thing I had to do years and years ago with the first time I dealt with chronic illness, was I needed to take a two years off of work, and that required us to move and to downsize quite a bit and go to a place that wasn’t the perfect place for me, but where my husband could work.

Dr. Jessica Drummond (01:21:33) – So, you know, sometimes we have to take bigger jumps. In your case, you know, you’re maybe able to stay in the same place, but your partner is taking on more of the financial weight. So, you know, that’s part of the ebb and flow of life to anything else you want to say about that.

Federica Torri (01:21:50) – No, it’s definitely I really noticed a huge improvement of my mental health when I prioritized connection in the last six months. I went from there’s no yoga studio in the area to finally finding a yoga studio and just having community, even if they’re not cooking for me, or it’s not that they’re delivering, but the connection, it gets you out of that free state very much.

Dr. Jessica Drummond (01:22:15) – Absolutely, absolutely. There’s two really, really evidence based things in terms of lifestyle medicine and whole human health, and those are connection with other humans. Any safe spaces, any safe people in conversation and exercise. That’s it. So, so that’s so valuable. So you’ve found that that’s key. And then the next thing we think about is we kind of continue.

Dr. Jessica Drummond (01:22:43) – The circle is like what is your next set of goals. But for now I think there’s plenty of work to do in this awareness of where the real challenging piece of the physiologic puzzle is digestive, immune, nervous. You’ve got lots of tools, you’ve got an initial morning routine. And then, you know, normally what I would say is let’s meet in a month and we’ll see how it’s going. This sounds.

Federica Torri (01:23:10) – Great.

Dr. Jessica Drummond (01:23:11) – Excellent. All right. Anything else you want to share before we wrap up today?

Federica Torri (01:23:16) – No, I think it was great because in this session we really went through so many different levels that sometimes you explore with different practitioners. And so I think tying things up, I don’t know, it makes more sense. It gives more sense to everything that’s happening.

Dr. Jessica Drummond (01:23:31) – Yeah. And I. Think that’s such a valuable insight, because it’s almost always the case with any complex chronic illness that you’re going to have a team. I’m not going to be the expert in everything. I’m certainly not an excision surgeon.

Dr. Jessica Drummond (01:23:44) – And so for our practitioners who are doing this work, your work when you take a coaching led mindset, is often to help people tie together and prioritize the recommendations and insights that they’ve gained from their whole team of professionals in alignment with their goals. Not so much the goals necessarily of their other professionals. So yeah.

Federica Torri (01:24:10) – Thank you so much.

Dr. Jessica Drummond (01:24:11) – Thank you so much for sharing. Thank you for spending so much time with us today. And I hope this was really valuable for you. It was thank you, thank you. Wow, that was such a wonderful conversation. And I think what I most want you to take away from it is that how we integrate working with the client and her vision and her goals and her priority challenges in a situation where everyone’s nervous system is being constantly regulated, yours and your clients is your fastest path to helping them integrate such a complexity and to making it easy and doable and able to be specifically supported by their web of support. So when your clients leave their appointment with you, the most important thing is that they feel like they are on the path and that they are beginning to live their vision now.

Dr. Jessica Drummond (01:25:18) – Because healing and living with complex chronic illness is a multiple, multi-year, multi-decade experience. And for people with endometriosis, you know, as far as we are aware at this time, they will always have this underlying vulnerability. So we want to fit in to their lives what it means to be healthy at this moment and how that can continue to expand. And then I hope you learned some unique specifics about how endometriosis impacts the nervous, digestive, and immune and endocrine systems so that we can help people really heal physiologically from those root causes that are well connected to their emotional health, their spiritual health, and their community health. So again, I thank Federica so much, and I hope that this episode will really inform your practice to start thinking in a coaching mindset. Even if you are working in a clinical setting. I’ll see you next time. Thank you so much for joining me today for this episode of the Integrative Women’s Health Podcast. Please share this episode with a colleague and if you loved it, hit that subscribe or follow button on your favorite podcast streaming service so that we can do even more to make this podcast better for you and your clients.

Dr. Jessica Drummond (01:26:53) – Let’s innovate and integrate in the world of women’s health.