When Multiple Surgeries is a Sign of Endometriosis with Dr. Ginger Garner

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.

Dr. Jessica Drummond (00:01:01) – Hi, and welcome.

Dr. Jessica Drummond (00:01:02) – Back to the Integrative Women’s Health Podcast. I’m your host, Doctor Jessica Drummond, founder and CEO of the Integrative Women’s Health Institute. Today I have a really exciting and I would say fascinating guest for you. We dive deep into her story of living with endometriosis for decades. We’re talking in the neighborhood of 40, 50 years and having all of these rabbit holes of surgery, of integrative health to manage her symptoms of fertility challenges, and finally getting accurate diagnosis without the medical gaslighting that she experienced for decades beforehand.

Dr. Jessica Drummond (00:01:53) – So what I love about this conversation with doctor Ginger Nash is she has the skill set and the training to really understand what happened to her on a physiologic level, but she also has this experience, both with clients and with her own journey, that helps us backtrack and learn from her experience in the sense that she can now turn around and look at her story and show us as women’s health professionals, some places where things were missed, where different professionals should have been seen like pelvic health, physical therapists, functional nutritionist, health coaches, people that have a wider, broader view sometimes of, you know, within the health care system that we live in, that’s very siloed. So I want you to look for some of the key pieces of her story that could change how you screen for endometriosis in your practice of any kind, whether you’re in primary care, in women’s health, in orthopedics, in digestive health, in pelvic health, this episode is for you. And if you’re living with endometriosis or suspect you or a friend or family member might have endometriosis, this is an essential episode for you.

Dr. Jessica Drummond (00:03:16) – So let’s dive in. Hi everyone. Welcome back to the Integrative Women’s Health Podcast. I’m here with doctor Ginger Gardner. I’m so excited to share with you our conversation today about endometriosis, her experience, and her vast experience as a clinician, working with people with this condition and what she’s learned in the last couple of years. So welcome, Ginger.

Dr. Ginger Garner (00:03:47) – Thank you. Thanks for having me, Jess.

Dr. Jessica Drummond (00:03:50) – So let’s start with your recent personal experience with endometriosis, and I would love to learn more about your personal and clinical insights on how orthopedic conditions can sometimes mask endometriosis.

Dr. Ginger Garner (00:04:09) – yeah, that’s a really good question. And it’s a place that I’ve personally lived for, oh my gosh, over a decade. But really my whole life, if you take it, you know, retrospectively and the current theories of, you know, the genetic catalysts for endometriosis, then it’s been with me forever, right? But in the last ten years, I think the first time that I really began to appreciate the connection or the gap, I’ll just say the gap between sports medicine and pelvic health was after I gave birth to my third son, and I had a birth injury where a very well-meaning lad nurse, but nonetheless one that maybe wasn’t a bit up to date.

Dr. Ginger Garner (00:04:53) – And of course, back then they weren’t paying attention to what they were doing with women’s legs during delivery. And so my hip just got. Utterly destroyed. However, it brings up a really important first point. If endometriosis was obviously already there all along, how many people can be misdiagnosed with a hip labral tear from oral acetabular impingement? Not that they don’t have it, but when we read the literature, we clearly know that a labral tear doesn’t have to cause pain. And FYE is not necessarily a surgical indication to have this massive hip preservation surgery, which I went on to have three years later after he was born. So when I look back, there’s that huge overlap between orthopedic conditions, which can be very valid, just like the four surgeries I had prior to endometriosis. Hopefully will be the final excision surgery where each time it wasn’t that. Yes, you could say should each surgeon have biopsied, you know, the tissue to make sure that it wasn’t endometriosis? Yes, 250%. Absolutely. And they didn’t.

Dr. Ginger Garner (00:06:05) – So that’s the first problem. But the second point is that each time they went in, they found another very valid driver of the issue. And so now, you know, as a clinician personally, this has been an incredible experience. I wouldn’t wish on anyone. But the flip side of that is it’s made me so much more aware of and very picky about how I go about evaluating that overlap between orthopedic and pelvic health, knowing that there could be these underlying systemic drivers like endo.

Dr. Jessica Drummond (00:06:38) – Well, and especially so if we’re putting our clinician hat for all the professionals out there listening or for people struggling with essentially a multiple continued kind of surprising, if you will, orthopedic injury. Now, certainly a birth injury can be very significant, just like a sports injury. But the fact that you had multiple hip surgeries without the underlying problem being corrected despite doing pre-op care, doing good post-op physical therapy, working on alignment like I think a big red flag for me, that this has some systemic or cellular component or system.

Dr. Jessica Drummond (00:07:19) – I guess physiologic systems component is that you had to have multiple surgeries on the same joint. Would that ring true?

Dr. Ginger Garner (00:07:28) – Well, the surgeries actually ended up being all sorts of a la carte, various things, which makes it even more colorful. And it really underscores, I think, what we’re trying to bring to light to people suffering with endo or these overlapping issues, too, because it’s not just lesions, for example. So in this case, what happened, which now in retrospect, things come together and look a little bit more clear. But when you’re living them, you’re always on the edge of total disability, not being able to manage, you know, your work and I have a private practice, I have a continuing education, you know, company just like you do. And so it can deeply resonate with anyone who’s self-employed, with anyone who has to maintain their job and just can’t step away for these incredibly painful, chronic experiences. They have to keep going. And so what happened was initially, there were red flags all along the way that when you grow up in a rural area without healthcare, and the very first instance, my first surgery was to for probably a very valid issue, which was a ruptured appendix.

Dr. Ginger Garner (00:08:39) – So then as time goes by, you think when you have a second surgery and they find adhesions everywhere, you think that surgery in a tiny hospital where they just vertically opened me up at two years old, that was messy, right? So you think about that. Everyone has adhesions post-op, you know, abdominal surgery or orthopedic surgery. You can have, you know, adhesions. And that’s why therapy is so important for follow up and follow through. So you can get down these little rabbit paths. And so one of the surgeries, for example, was I began to have right upper quadrant issues. So for everyone nonmedical listening in gallbladder area pain. And I knew that it was as a health care provider, I’m like, oh, my gallbladder is quitting on me. Why? Other than being female, I have no risk factors for this at all. And of course, here comes the medical gaslighting. So what ensues? You pop around to all the specialists trying to get someone to listen. Being a healthcare provider sometimes makes absolutely no difference, and in this case, it didn’t.

Dr. Ginger Garner (00:09:46) – Even though I said it’s my gallbladder, it’s my gallbladder cannot process fatty foods. It’s just not happening. I’m on digestive enzymes. I’m on activated charcoal. I’m doing all of the things that you would do holistically lifestyle and functional medicine. Nothing worked. So finally I got a surgeon to listen. She did a nuclear scan for the gallbladder, and I was functioning at less than 10%, so it was already dead. For all intents and purposes, I couldn’t keep it. It was doing me no good, and I was losing weight, and I couldn’t afford to lose any more weight after going through that through a year. So when she went in, she found adhesions everywhere. They were in the transverse abdominis, all the layers of the abdominals. The liver was scarred down to the respiratory diaphragm, making breathing really painful on a regular basis. That had happened my entire life, right? Just no one really paying attention. Did they biopsy for endo? No. Right. So that’s another surgery. And then there were others after that that came.

Dr. Jessica Drummond (00:10:47) – Right. So really, you know, your story is such a stunning example of exactly what happens in our conventional system. It’s like this issue okay, take out the appendix, this issue okay. Take out the gallbladder. No one’s really kind of like well why are there all these other adhesions. That’s not really normal for just a gallbladder challenge. You know, certainly it’s a little tricky given that you have this history of the two year old kind of messy appendix surgery. I’m starting to wonder, have you done any genetic testing? Because more and more, I’ve been looking at the genes of people with endometriosis and finding pi or one or sapien one snip. So there’s this tendency towards fibrosis, if you will. Have you seen anything like that in your experience?

Dr. Ginger Garner (00:11:38) – Yeah, I have done genetic testing. I’d have to go back and look for those particular snips. It’s been an all encompassing journey of helping other women through it. And while I was just kind of silently dealing with it on the other end, you know, the other thing to throw into the mix with the genetic drivers, of course, I have multiple family members with Endo.

Dr. Ginger Garner (00:11:59) – My mother had incredible endo that at the time. You know what I’m going to say that they treated they gave her a everyone together hysterectomy.

Dr. Jessica Drummond (00:12:07) – Yes. Oh geez.

Dr. Ginger Garner (00:12:09) – Which no that didn’t help. That wasn’t the cure. But another interesting surgery that I had. Speaking of both genetic tendency towards, you know, fibrotic issues was a surgery where I ended up in the hospital on day two or day three on my PCA morphine pump because they had no idea what was wrong with peritonitis. Of course, now inflammation is everywhere. Things are spreading and growing. They went in and said, oh, it was just another appendix. Fascinating.

Dr. Jessica Drummond (00:12:39) – Oh my gosh.

Dr. Ginger Garner (00:12:39) – Stuck in another rural hospital, unable to transfer anywhere after being so incredibly sick for several days and just getting worse and worse and allowing them to go in and do a scope.

Dr. Jessica Drummond (00:12:49) – And so how many years ago was that roughly?

Dr. Ginger Garner (00:12:51) – Oh, gosh, over a decade.

Dr. Jessica Drummond (00:12:53) – Okay. Now so you have this I think there’s a few key points I want to emphasize here.

Dr. Jessica Drummond (00:12:58) – One, as you mentioned a couple times, that your living situation happened to be in more rural areas. And I think this is something we don’t talk about enough or isn’t acknowledged enough, the access to even surgical skill or experience that you would get in a large city or teaching hospital environment is very different from what you could get potentially at a community hospital in a more rural area. How do you think that impacts essentially access to care?

Dr. Ginger Garner (00:13:33) – I think it takes out entire states, not just regions, because one surgery I had at a teaching hospital at UNC Chapel Hill where I went to school, but which is an excellent school, excellent teaching hospital I now live in, sandwiched between, well, we’re one, two and three largest cities in North Carolina are all within an hour of each other. So I live right in the middle of the Mecca of healthcare and what we have. And ten years ago, again, I went to one teaching hospital, and then I had this stuck in the middle of nowhere rural experience, and it ultimately drove me to run for office after or really in the middle.

Dr. Ginger Garner (00:14:11) – I thought it was after all of these health scares were over, but really, it was kind of dead center in the middle and sandwiched in between, finally getting a correct diagnosis and trying to mitigate whatever tendency my body has to love to scar really poorly, right? Or have a problem with fibrosis. So I think that it’s a passion point for me to it’s driven my action since then to, like I mentioned, run for state Senate and then currently our legislative chair for American Association in North Carolina and several other roles that are all legislative advocacy, policy writing positions because it’s that important, having lived it and also seeing family members suffer unnecessarily and one pass away unnecessarily.

Dr. Jessica Drummond (00:14:58) – That’s horrible. Are there any? Recommendations you have for health professionals or individuals listening to this who do live in states or regions of states that don’t have very good access to you know, that, you know, we talk about the limitations of good conventional medicine in terms of like, everything being siloed. But there’s also just the limitation to just flat out all kinds of care.

Dr. Jessica Drummond (00:15:25) – As you said, when you’re in an environment that just doesn’t have the skill set and knowing kind of the corporate drivers behind health care, is there anything that sort of individual practitioners could start to do to shift this access challenge?

Dr. Ginger Garner (00:15:41) – Oh goodness, I’m thinking about it on all levels. Actually. I’m thinking about it from the practitioner level. And I have been in, I think, different camps. And what I mean by camps is different camps in terms of being frustrated with the limitations of our current professional organizations, where we feel like there’s underrepresentation or they’re not addressing the 40,000 foot view of access fast enough or in all of the right ways, or speaking from Pts having giving us direct access in all states. So one of the things that we can do, because I think when the public can very easily be misinformed, that, for example, if they have back pain, they go to an orthopedic surgeon as an entry point of care. Right? When the research clearly shows us, particularly from the US Army, that when Pts are a primary care provider for orthopedic issues, back pain is probably the most common one because it has such a systemic impact on us, and nearly everyone is going to have it at some point, right, that it costs less to order, less imaging, they have more rights.

Dr. Ginger Garner (00:16:51) – They can order imaging in the US Army. They order less imaging. The outcomes are better, the patient is happier, it costs the system less. And for some reason, we are not applying that evidence, you know, across TT access in the US. So from a practitioner standpoint, for all the Pts listening or anyone who cares about having TT access is get involved, know who your representatives are, particularly at the state level. And I say state level because many people think, oh, I’ll contact my Congress member. Most of the decisions that give you critical access to care are made at a state level. And so if you are a healthcare provider or a person, you know, a consumer of health care, know who your representatives are and know what their stances are in terms of public health policy, you might be very shocked to learn who you’re actually voting for is a reason that that rural hospital in a far fetched area in your state closed down because then they didn’t have the funding for that, or they couldn’t keep the doors open.

Dr. Ginger Garner (00:17:54) – So know who you’re voting for first, specifically if you’re a practitioner as much as if you love Apta, wonderful. If you hate abt a okay, fine. But it’s the organization that we have that represents us right now that is working hard to be able to improve access. And if we don’t support it, you have no chance for improving access to health care, particularly if we talk about the efficacy of Pts and how great they are at, well, checks. Imagine if we could have a well check every year, right? From a pelvic PT of course we’re talking about pelvic PT, but also ortho. It would be amazing and would cut down on unnecessary series of injections for back pain and things that we absolutely know don’t work, especially when people come in with the hip issue or the endo issue. It allows us to then tick those red flags and go, you know what? I think you need a referral to this provider. So yes, I got a little bit into the political realm because health care is more important than politics.

Dr. Ginger Garner (00:18:55) – So I don’t care what party you’re a member of, right? Talking to the listener here doesn’t matter what party you’re a member of. Health care is too important to be a party or a partisan issue. So if you get involved, great. If you are in a state and you’re wondering if you have good access to hip preservation specialists, endo specialists, which I just want to say for a moment, you need to go to an endo excision specialist or an orthopedic surgeon who only does hip preservation, nothing else. Otherwise you’re not going to have good outcomes.

Dr. Jessica Drummond (00:19:28) – Yeah. Yeah. So to sort of summarize that, I think one of the key things is that physical therapists, in a way, are uniquely positioned even within the conventional medical system, to provide more holistic care, because our training is actually cross-disciplinary from the standpoint of neurologic, orthopedic, pelvic health, reproductive pediatrics, geriatrics. Yeah. And so women’s health, men’s health. And so I think that. We are uniquely positioned within the conventional medical system, which does give them greater access to a wider population.

Dr. Jessica Drummond (00:20:08) – Just because we in many cases can access insurance or insurance payment systems, which are very far from perfect and, you know, not my favourite system, we could go deep into that. But it does give access to people with less financial resources to be able to then and physical therapists within our training if we are subspecialty trained or not, even subspecialty trained like trained, have additional postgraduate training and nutrition can also provide that functional medicine perspective. Now, functional medicine is not a specialty. It’s a perspective that allows for that root cause thinking. So if a physical therapist sees a person like you who had multiple hip surgeries, organ surgeries, history of adhesion, family history of endometriosis, there’s a lot more red flag opportunity because most orthopedics don’t learn about endo. Most general surgeons don’t learn about endo excision. Surgeons, which are very skilled surgeons, are essential for endometriosis care but are relatively rare within the world. Not only this country.

Dr. Ginger Garner (00:21:21) – Hard to access.

Dr. Jessica Drummond (00:21:22) – So I think if you’re a person listening to this, or even a practitioner listening to this who feels like there are multiple things going on that started either at birth or in early prepubescent puberty, that there’s this intuitive sense that they’re connected, but everyone’s like, oh, that’s just, you know, how surprising, like, you now have a gallbladder thing.

Dr. Jessica Drummond (00:21:46) – Oh, how surprising. You now have another like second.

Dr. Ginger Garner (00:21:49) – Appendix.

Dr. Jessica Drummond (00:21:50) – Like another one just grew or whatever. Just there. So, you know, especially because endo has a lot of digestive symptoms, you were able to look back and connect some of those. Let’s talk about your symptoms as a person just living in this experience that didn’t seem connected before. But now that you have the endometriosis diagnosis, what seems more obvious in retrospect?

Dr. Ginger Garner (00:22:14) – Yeah, I feel like I’m a little bit of a weird unicorn, and I’ve met a few other patients that that have come in with endo and wide ranging, broad symptoms, but yet have been able to get pregnant. But that didn’t mean that I struggled hardcore with infertility for a decade over a decade.

Dr. Jessica Drummond (00:22:35) – So you were able to get pregnant, which is one of the reasons why people weren’t looking for endo. And yet it was a struggle.

Dr. Ginger Garner (00:22:42) – Yeah I was already a practitioner using that functional medicine perspective. Either Veda yoga, all of the things that we know about integrative and lifestyle medicine that work to mitigate what’s going on systemically with disastrous ism, dis circadian ism, all of the things that we know environmental pollutants that have estrogenic effects that would drive growth.

Dr. Ginger Garner (00:23:05) – I was really hard core controlling for all of those in order to try and treat the fertility issue, which ultimately worked. It worked enough. Yeah. But at the same time, it delayed diagnosis. Right? And that’s why I say weird unicorn, because I believe that had they gone in AD, no, meiosis was a secondary diagnosis that was inconclusive from the lab. The surgeon said it looked just like it, which meant I would have had a hysterectomy before I had a chance to be pregnant, which then, oh, it gets me emotional to think about, you know, that’s why I’m so passionate about helping women with this issue, because some of them are coming in, you know, and there are so many functional medicine perspectives that can be taken to get them to that success point that, you know, I was in was I pain free during that time? No way. The drivers got so bad, particularly as you enter into perimenopause, as into menopause, where and this is the other myth that we can go ahead and dispel is that endo gets better as you enter into perimenopause and menopause, which I had two endo patients I think, last week, and both of them had heard the same thing.

Dr. Ginger Garner (00:24:14) – You know, they had hysterectomies and they had their Gyn say, oh, don’t worry, it’ll get better at menopause. And I just had to lower my head and then just say, I’m sorry, that’s not correct. Maybe if I wasn’t almost a 30 year veteran and I would have been more diplomatic about saying it, but I just don’t have time to waste on endo illiterate professionals anymore. Right. And so setting that record straight, so those symptoms that I had obviously infertility, which so many women with endo have and respiratory pain which to the average ortho right to the average OBGYN, they’re going to entirely ignore that. Right. They’re going to say side stitch, go hydrate or you just have anxiety, you know, take a deep breath. Absolutely. Not when I’ve had my respiratory diaphragm cleared from my liver twice already. Right. And in hopes this time that with the PRP hopefully will, you know, tamp down on the adhesion redevelopment. But respiratory pain really horrible cycles that you know they’re heavy because you’re a pelvic RT right.

Dr. Ginger Garner (00:25:23) – You know they’re too heavy. But you also start to think about again from a functional medicine perspective, how well is my liver metabolizing the estrogen that it has? Am I in this kind of dis estrogen ism situation or season? So I treated it. And guess what? It got better, right? So when you’re self treating these things you can mitigate them. But really, really heavy dysfunctional periods to the point of having persistent pervasive anemia even after the cycles were done, like permanently done, still anemic malabsorption, things that we don’t consider strain on my labs. Right. I don’t think that if you’re not a health care provider, maybe you’re not paying attention to it. But I noticed that in spite of eating a really healthy, anti-inflammatory, Mediterranean driven type diet, I wasn’t absorbing antioxidants, I wasn’t absorbing calcium.

Dr. Jessica Drummond (00:26:15) – Or there just wasn’t enough at all. Like you just needed so much.

Dr. Ginger Garner (00:26:20) – Yeah, even with supplementation. So with the diet plus supplementation, plus bone density, weight bearing, building, exercise and all the things that we know are good to prevent these issues from happening, they still were happening.

Dr. Ginger Garner (00:26:35) – And so that kind of the breaking point for Symptomology for me was I’ve had this happen frequently, but of course, it can be very much passed off and ignored. Fortunately, I never had any bladder symptoms, but there were lots of bowel symptoms. There were stretches of kind of unexplained Sibo that made absolutely no sense based on what I do for a living and how I practice so persistent things like that. But really the last one was nerve related. So think sacral plexus, sharp searing. You know, people might mistake it for sciatica, right? Type pain.

Dr. Jessica Drummond (00:27:12) – So for people who are less clinical, that’s like all the nerves that come out of the lower part of the spine. So it could be anywhere in the back, in the hips and the pelvis, in the down, the legs burning all of that.

Dr. Ginger Garner (00:27:25) – Yeah. Like piriformis syndrome, a thing that just rarely is a driver of anything, you know. Yeah.

Dr. Jessica Drummond (00:27:32) – Just but it’s.

Dr. Ginger Garner (00:27:32) – Like band syndrome. If you’re from a syndrome, I’m like, don’t talk to me about that.

Dr. Ginger Garner (00:27:36) – That’s not an actual diagnosis. But that’s what it would have been mistaken for is piriformis syndrome. I would have been sent home from the E.R. with, you know, more drugs, more meds, just to mask everything. But I ended up in the Ed anyway because I couldn’t breathe. I could not stand up, I couldn’t walk, and I went through these bouts that I’ve actually told no one before now. So this is the first time I’ve ever shared this story.

Dr. Jessica Drummond (00:28:01) – Thank you for being so vulnerable.

Dr. Ginger Garner (00:28:03) – Yeah, publicly. Where no one knew this because you didn’t want to draw attention to yourself. You’re a clinician. You need to go to work and not be the sick one. So I would have to take days off because I couldn’t walk. I’d have to emulate around my house with a cane. I could not bear weight on my leg.

Dr. Jessica Drummond (00:28:22) – And the shortness of breath was a because it was so painful. Or did you actually have like, lung pathology?

Dr. Ginger Garner (00:28:30) – I didn’t end up having thoracic endometriosis.

Dr. Ginger Garner (00:28:33) – The adhesions, which of course can come from lesions, were pretty terrific. And of course they had been released once already, but without a biopsy and knowing what in the world was going on there. So between the nerve pain and the lower body, and then the respiratory pain in the upper body, my middle son and my husband had to carry me to the car and I was like, I just need to know it. It’s not catastrophic. It’s probably endo. So I got the Ed and I was like, listen, I have triaged myself. I do not want your pain meds. I just want to make sure there’s nothing else catastrophic going on and then send me home. Like seriously. And that was kind of the breaking point. I was like, okay, it’s clearly not getting better. I know what this has to be. I have mitigated it, mediated it, managed it. All of these years, I managed to get three kids before they had to basically take everything out. I feel lucky that I got that far and that was it.

Dr. Ginger Garner (00:29:30) – Yeah. Well, first.

Dr. Jessica Drummond (00:29:32) – Of all, thank you for sharing that because I think it’s so valuable for people to recognize. You know, I gave a talk back in October at the pelvic conference in Atlanta. And, you know, the reality is that practitioners and patients are not like two different groups of people. There are people who are practitioners and there are patients, which is absolutely everybody. And when practitioners become patients and that they have physical challenges. It is, they might understand them better or more quickly or from a particular perspective. But we’re all still human, and having those experiences is not something we’re insulated from because we have particular degrees. You know.

Dr. Ginger Garner (00:30:16) – We’re still in the same waiting line as everyone else for the person who might be able to listen or give you an answer or gaslight you, we’re in the same queue as everyone else.

Dr. Jessica Drummond (00:30:26) – And so a couple of things. I think in the world of Covid and post-Covid, your symptoms of acute nerve pain and acute respiratory pain driving you to the emergency room is actually a good thing to do because of the clotting challenges that we’re now seeing in women, especially perimenopausal and menopausal, who have had Covid or Covid vaccine, either one at any time, which is pretty much absolutely everybody at this point, usually both.

Dr. Jessica Drummond (00:30:55) – So I think that’s a red flag for people to just be aware of that. That’s something that does have to be more urgently ruled out if you have these symptoms, and it could come from something else. But in the world of a, you know, chronic vascular condition that everybody’s had. And then the second thing I want to talk about a little bit more now is so I recently did a podcast, full episode on endometriosis and perimenopause and menopause. And the data shows us that actually endometriosis is diagnosed in about 14% in perimenopausal women, 14 and 15%, and about 4 to 5% of post-menopausal women. I think two things are happening right now, and I would love your opinion on this. One is that we have cases like yours, which is a clear long term delay of diagnosis. Your diagnosis was managed because of your knowledge and also because you had other drivers that seemed to be the pain driver or the symptom driver, and you just didn’t have diagnosis until you were. I don’t know if you’re perimenopause or menopausal, but in that group like over 45 or I actually think though, there is a world in which some of these diagnoses are that the trigger itself for endometriosis expression, particularly in perimenopause, when we have the changes hormonally, is actually, you know, endometriosis has a genetic driver, but it’s not always fully expressed.

Dr. Jessica Drummond (00:32:21) – There’s a trigger of endometriosis, you know, as an example, I’m always talking about I have a client who has an identical twin sister who does not have endometriosis. So I think sometimes perimenopause is the trigger and people are having essentially new onset endometriosis at perimenopause. What are your thoughts?

Dr. Ginger Garner (00:32:41) – I think that could be absolutely true because if you think about the world we lived in, gosh, even in the 70s. But, you know, go back further than that, right? And of course, I was born in the 70s. I turned 50 last year. So it seems like the 70s were 30 years ago, not 50 years.

Dr. Jessica Drummond (00:32:58) – I agree, I agree. Yeah.

Dr. Ginger Garner (00:33:00) – So now I have to say go back 70 years to the world we used to live in, where there weren’t thousands and thousands of chemicals that were estrogenic and endocrine disrupting. And so for everyone listening, that’s like screwing up your hormones and your balance and thrusting, you know, whether it’s children entering into puberty earlier or we have this complicating factor of even without the pollution, when you go through perimenopause and menopause, you have these hormonal dysregulation, but then add in the environmental aspect of it.

Dr. Ginger Garner (00:33:33) – And why wouldn’t that be true? Why wouldn’t perimenopause to menopause be a valid onset or a driver of endometriosis for some women, I totally agree.

Dr. Jessica Drummond (00:33:43) – Yeah, yeah. So this has been so informative because I think your story has so many nuggets of insight for people that may be wondering like, what the heck is going on for me? Like, do I really have a second appendix? Like what is going on? And your story really highlights the diversity of symptoms that can be expressed with endometriosis. Is there anything else you want to share about? Okay, let’s say you now get your diagnosis whether you’re in perimenopause, menopause or earlier and you’ve had good skilled excision surgery, you found that surgeon. And we talked a lot about this in our prior episode with Shannon Cohn and Sally Carroll. So people can go back and look at those for like great resources for surgeons. And then now that you’re living in the after of good surgery and clear diagnosis, what’s kind of your day to day routine? Because it’s not like it’s just over.

Dr. Jessica Drummond (00:34:43) – You still have to take care of your systems.

Dr. Ginger Garner (00:34:46) – It is two part relay, two part meaning what I’m doing as a person now. It’s inevitable that I’m going to pull my training in integrative medicine, lifestyle medicine, and all of the things that we can do with a functional medicine approach. I’m pulling that into my pelvic PT, so there’s two arms of it. There’s the integrative part, and the more holistic, a 40,000 foot view that you get by saying, okay, I need to manage stress, obviously, but I also need to make sure that my liver can metabolize the estrogen that I have since one of the at least four ways that endometriosis is a systemic condition is driven by gut health, inflammation, you know, estrogen. And so I need to control for that. So I’m looking at obviously my day to day nutrition and making sure that between nutrition and environmental factors that I am controlling any kind of dis estrogenic things that I could come in contact with, which is everything from the soap and the shampoo that I use to making sure that foods are whole and plant based.

Dr. Ginger Garner (00:35:55) – There’s the stress aspect of it and managing that, and also making sure I get good sleep. That’s incredibly important, which as progesterone tends to tank, then that means looking into whatever HRT or MT in this case is going to be most appropriate, especially given the, you know, the endometriosis background, which I’ve thankfully found an amazing balance on that where I get great sleep, I have good energy levels. I don’t have any issues like metabolic issues, weight management struggles because I’m controlling for those, you know, those variables through lifestyle medicine. But when I get past that, plus physical activity obviously, which is kind of the bread and butter of physical therapy and making sure that I get enough, you know, foot to ground activity in terms of weight bearing, prevention of osteopenia and osteoporosis, incredibly important.

Dr. Jessica Drummond (00:36:47) – Especially all those years of like lack of nutrient absorption because of the endo.

Dr. Ginger Garner (00:36:53) – Exactly. Because my bowel was in the wrong place. I’ll just put it that way. It was in the wrong place.

Dr. Ginger Garner (00:36:59) – That’s where the thrust of all the lesions and everything was. They were deep infiltrating lesions there, explained absolutely every, you know, symptom and sign that I would have ever had. That’s important to me to then treat that from a pelvic PT visceral mobilization perspective. So then when you look at what I need to do on an ongoing basis, pelvic PT will never end. After having excision surgery, I also had a hysterectomy at the same time. They were able to preserve the ovaries. They actually survived all those decades, which is amazing and preserving the cervix as well. So some good things that came out of it. But also there’s the bit of a red flag for women who have or tend to have hypermobility. So hypermobility and the overlap with endometriosis is important. So from a pelvic PT perspective in treating myself and treating anyone else, I’m going to look for aspects of hypermobility, because then that puts women at increased risk, myself included, of pelvic organ prolapse, of urinary incontinence, of bowel issues.

Dr. Ginger Garner (00:38:02) – And so I am doing all the treatment stuff that I would do for anyone else. Plus, I have to be very honest to and with myself and say, you know, I can’t do all that myself, so I have to get other clinicians to go in and do internal work. I can’t do my own internal work. I can image myself. And so I’ll do ultrasound imaging and see, oh, where’s the inner rectal canal? Where’s the bladder? Is the bladder neck sitting up high enough or what do I need to do about that. So hyper possessives is one thing I found really helpful. Visceral manipulation and mobilization. Super helpful, especially myself included. Again, women who have the tendency not to scar well and not to maybe heal as well. We want to make sure that we’re doing everything we can to mitigate adhesions in that way. So I use dry needling again. I use, you know, VM visceral modes. And that’s been really, really helpful. But that’s kind of a day in the life if you will.

Dr. Ginger Garner (00:39:00) – Fortunately, I’ve not had a days return of any of that pain at all. None of the severe pain. Now I’m just dealing with the post-operative. It’s been a little bit over six months, which is still early, really still pretty early. Carefully watching, you know, gut microbiome health and slowly getting back into physical activity. For example, two weekends ago, I got back in the saddle literally.

Dr. Ginger Garner (00:39:26) – Yes.

Dr. Ginger Garner (00:39:28) – For the first time I cantered, which is a lot of downward pressure gradient on your pelvic floor. And it felt great. It felt wonderful. So that’s.

Dr. Jessica Drummond (00:39:38) – Really nice. We’ll just end on this. Like, now that you’ve gone through this experience, have your vast knowledge that you have. From your 30 years of experience, and then your own kind of lifetime of navigating this disease. Is there anything you feel inspired to change about kind of your own life, vision, stress, career, work like downshift, upshift, change at all? How is it impacted that?

Dr. Ginger Garner (00:40:06) – Yeah, that’s a good question.

Dr. Ginger Garner (00:40:09) – In the midst of scheduling excision surgery last year. Right. So I was already planning to take a sabbatical. I’ve never taken one. I’m self-employed, so it’s not like I work for an academic institution and I can just get leave. Right? You stop working, you stop getting paid. Right. So it didn’t matter, right? It didn’t matter whether or not I had that steady income if I didn’t have my health. And so I planned a month off, which I have never taken before unless I had surgery. And I’ve had major surgery so many times that that absolutely doesn’t count. Being postpartum with two kids under two does not count, right?

Dr. Jessica Drummond (00:40:50) – Not a sabbatical.

Dr. Ginger Garner (00:40:52) – No, that is not a sabbatical since we’re defining what breaks are. Right. So for all the women out there listening, just because you took time off postpartum, that is not a break. Surgery is not a break. And that’s the only time I had ever taken a break is forced breaks for these catastrophic things that were happening.

Dr. Ginger Garner (00:41:08) – So I took a month off and I came back and changed everything. Everything about what I was doing. I’m winding down a big segment of my continuing education business, not to end it, but to rehome all my continuing education programs so that I’m no longer managing those. That’s a huge, you know, undertaking, as you know, because you run an institute as well. So winding certain things down, shifting my focus, you know, in clinical practice, changing my schedule, making sure that I actually carve time out to go to the barn, you know, and ride things like that. I mean, we got one messy, beautiful, amazing, terrifying, short life. And there’s no reason to waste a second of it. You know, women are so strong and what they have to come up against with workplace discrimination, sexism, medical gaslighting, specifically in pelvic health and not being taken seriously. That claiming your total. I guess I use a voice to pelvic floor approach and treatment, so I use it kind of trauma informed to to claim the power of your voice all the way down to your pelvic floor is important.

Dr. Ginger Garner (00:42:18) – You know that you’re heard, that you use your voice in a way that you want, that your spine feels a little stronger, right? That you stand up a little taller. That’s my mission. And anything that doesn’t align with that I can just happily say no to. And so yeah, it’s changed everything.

Dr. Jessica Drummond (00:42:32) – Thank you so much, Ginger. Thank you for being here. Thank you for sharing your insights, your story, your skill, your perspective. Where can anyone who would like to find more about your work or come and work with you as a client? Where can they find you.

Dr. Ginger Garner (00:42:47) – Or a clinician? Come work at the practice.

Dr. Ginger Garner (00:42:49) – Yeah, come work with you.

Dr. Jessica Drummond (00:42:50) – That’d be great.

Dr. Ginger Garner (00:42:51) – Yeah, we’re looking for people. Well, a couple of different ways. One, if you’re on on Instagram, you can find me at doctor Ginger Garner on Instagram. Also on YouTube, I have loads of free content and plans in the works for other things that are offered. So you can come give me a follow on YouTube.

Dr. Ginger Garner (00:43:08) – I’m always talking about the voice to pelvic floor perspective and my ongoing journey with endometriosis. And you can also find me at Garner Pelvic Health. Com in the clinic I do free consults. It does not mean that you’re going to end up seeing me. It might mean that I point you to, you know, an excision surgeon or a great pelvic PT in. Let’s see, I talked to two people from Michigan last week, so I just want to get people pointed in the right direction. If I can help you in any way, I will. So you can go to Gardner Pelvic Health. Com for first consults free and integrative lifestyle Mediacom. If you’re looking for training in obviously integrative and lifestyle medicine. So that’s how you can find me.

Dr. Jessica Drummond (00:43:51) – Thank you so much again for being here. Thank you for so vulnerably sharing your story and good luck with everything, including hopefully more force and sabbatical time in the near future.

Dr. Ginger Garner (00:44:04) – Absolutely. I’m getting ready to go to Scotland soon. So yep, I’m going to take off and go there.

Dr. Ginger Garner (00:44:08) – Thank you so much for having me on your podcast. It’s amazing. You just mentioned Sally and Shannon with the Endo episode. That’s fantastic. You all have to go listen to that if you haven’t, because that’s going to be a great one. I know I’ve had the good privilege of having them on my podcast as well, which I forgot to.

Dr. Ginger Garner (00:44:25) – Also follow your.

Dr. Jessica Drummond (00:44:26) – Podcast. What’s the name of it?

Dr. Ginger Garner (00:44:28) – Yeah, the Living Well podcast. It’s about ending medical gaslighting and women’s and pelvic health.

Dr. Jessica Drummond (00:44:33) – Excellent. All right. Thanks everyone for joining us today. And we’ll see you next week.

Dr. Ginger Garner (00:44:39) – Thank you.

Dr. Jessica Drummond (00:44:45) – Wow! I am.

Dr. Ginger Garner (00:44:46) – Immensely.

Dr. Jessica Drummond (00:44:47) – Grateful to doctor Ginger Gardner for sharing her story on her own health journey, what she’s learned from it, how she’s learned and integrated that with the wisdom she has from her physical therapy training, from her integrative perspective, and how she applies these things to herself, and how we can see from her story that integrative healing, with or without surgery, it can be really valuable for symptom management, for fertility.

Dr. Jessica Drummond (00:45:18) – And yet she had the unfortunate situation sometimes due to the health care access she was afforded, living in certain rural communities to having some limits on what she could actually get access to, and thus had these multiple rabbit holes of different orthopedic surgeries. More than one appendix surgery, which is crazy. So I really hope that you took at least a few really, really valuable clinical pearls. So share with us. Reply to the email about this. Send me an email at support at Integrative Women’s Health Institute. Com I want to hear your number one takeaway from this episode. Share it in our post on social. And if you want to learn exactly how to address endometriosis in this integrative, foundational way and all kinds of pelvic pain in this integrative and foundational way, you absolutely should be considering our Endometriosis Certificate program. So email us at. Support at Integrative Women’s Health Institute. Com if you have questions about that program, follow us on Instagram at Integrative Women’s Health, follow doctor Ginger Gardner on Instagram as well and all of her platforms where you can continue to follow her story of healing and the wisdom that she’s learned through this experience and the experience with her own patients and clients.

Dr. Jessica Drummond (00:46:48) – Thanks so much again for being here with us today on the Integrative Women’s Health podcast, and I’ll see you next week. 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. Let’s innovate and integrate in the world of women’s health.