Endometriosis Treatment: A Doctor’s Guide to Surgery Prep and Recovery

Episode: 4 Duration: 59MPublished: Endometriosis

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Welcome to The Dr. Brighten Show, where we empower women with science-based tools to take control of their health. In today’s episode, we tackle a topic that resonates with many: endometriosis excision surgery preparation. Dr. Jolene Brighten shares her deeply personal journey with endometriosis, blending her expertise in hormone health with firsthand insights. Whether you're considering surgery, exploring non-surgical options, or simply want to understand this condition better, this episode is packed with strategies, stories, and solutions.

You'll Walk Away From This Conversation Knowing:

  • The shocking percentage of women misdiagnosed or dismissed by healthcare professionals when seeking help for painful periods.
  • Why endometriosis is not just a reproductive issue—it’s a systemic inflammatory condition.
  • The power of personalized nutrition plans in reducing surgery risks and improving recovery.
  • What really happens during excision surgery and how to find the right surgeon.
  • Why 60% of women on birth control aren’t taking it for pregnancy prevention, and the implications for their health.
  • The surprising impact of anti-inflammatory foods like salmon and leafy greens on surgical outcomes.
  • How family history and genetics can shape your health journey, and why that matters for endometriosis.
  • The real risks of ignoring endometriomas and how they may increase cancer risks.
  • Critical steps to prepare mentally and emotionally for surgery, including journaling, affirmations, and finding the right support team.
  • The importance of consulting at least three surgeons before committing to a procedure.
  • Why your gut health and immune system are pivotal to recovery—and what to do about it.
  • How common supplements like omega-3s, vitamin D, and magnesium play a role in healing but must be carefully timed before surgery.

In this episode, you’ll learn the nitty-gritty details of surgical preparation. Dr. Brighten emphasizes the need to tailor plans to individual needs, diving into the role of nutrition, supplements, and mindset in recovery. She shares personal anecdotes, like her experience managing anxiety and the challenges of navigating medical systems as both a doctor and patient. The conversation highlights the lack of funding for endometriosis research, driving home the importance of self-advocacy and education.

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Links Mentioned in This Episode:

Don’t miss this empowering conversation. If you or someone you know is navigating endometriosis or considering surgery, this episode offers invaluable insights and actionable steps.

Transcript

Dr. Brighten: [00:00:00] Hey there, welcome back to the Dr. Brighten show. Today we're going to be talking about the preoperative plan for endometriosis excision surgery today. So if you don't know, hi, I'm Dr. Jolene Brighten. I'm a hormone expert and I have endometriosis.

I try to laugh about it, try to have a good time with it, um, as much as you can have a good time with a chronic condition that leaves you fatigued and anxious and in pain. So, I'm going to dive in today, share this with anybody who has painful periods, has periods that last 8 days or more, who has ever been given hormonal birth control to [00:01:00] manage their periods, to make the bleeding and the pain dampen down, uh, anybody that could potentially have endometriosis.

And also share this with people who know, you know they have endometriosis. So, I want to put all this information out there because, When it comes to endometriosis, there's very little research funding, which means there's very little research happening, which means that all of us are left to figure it out on our own.

I thankfully have a background in nutrition science, I am a hormone expert, like I have expertise, but I'm going to say this, all the knowledge in the world does not Mitigate the fears and the feelings, okay? I don't think that doctors share enough that like when we have to go to surgery we are freaking out sometimes or we're scared or we're asking a million questions or we have anxiety and I just Want to normalize that for people like you're gonna have all the feels and I have never talked to an endometriosis patient Nor anybody online has ever been [00:02:00] like yes, I was going to excision surgery I didn't sweat it was like no big deal.

Like it is, it's It is a big deal. It definitely is. So, we're gonna get in. I'm gonna talk about a nutrition lifestyle supplements. Primarily for preparing for excision surgery. Now, as I say this to you right now, I'm gonna be really honest. I'm supposed to have surgery in three days and I, I'm still considering backing out.

Because I Don't want anyone in my body like that, um, and so maybe I will back out. We'll see. I'll stay tuned. I will let you know. Either way, I am definitely prepping my body. Um, okay, I want to get into all of this, but I first want to start with like, maybe you're like, I'm not familiar with your story. I can do a much longer episode on endometriosis.

I did a two hour episode with Ram Cabrera, uh, who is going to be doing my surgery and is one of the leading experts in endometriosis in the world. He flies all around the world doing surgeries, [00:03:00] diagnosing women. I mean, he is just phenomenal. So we'll link to that. I want you to listen to that because there's a lot of insights that are shared in there.

Now for me, I had Extremely painful periods, down for the count, missing school at the onset of menarche. That means your first period. Menarche equals first time you have a period. It was horrible. I was bleeding like seven plus days. I would go through a pad every hour. I had to hug a hot water bottle. I couldn't breathe.

Couldn't really take ibuprofen because it gives me horrible stomach pain. It's just not for me. I really struggled with my periods and I was told this was normal. I was told this was normal by my mom, her friends, my aunts, my cousins. You know, there's a theme here, right? Family history, likely of endometriosis, but nobody getting diagnosed.

I was also told it was normal by doctors, nurse practitioners. Literally anyone I saw was like, yeah, hi, welcome to womanhood. It sucks, doesn't it? [00:04:00] It does, uh, when nobody is listening to you. And that, unfortunately, is how so many women go through their life and their experience with medicine, which is why this podcast and DrBrighten.

com and my books and everything I do exists. Um, I made a joke online the other day of somebody saying like, I will never forgive Doctors and health care practitioners as a whole who dismiss women's symptoms and I Made this comment of like I think a bigger person would forgive but I'm not that person I will take the rage that I feel of having been done dirty by medicine and I will channel it into as much content, material, education is possible to ensure it never happens to any woman who enters into my atmosphere again.

Uh, so I'll be holding on to my rage and, um, you will reap the benefits of it. Okay, so me. Horrible, horrible periods. Go through that for about three years. [00:05:00] Talk to another doctor. They're like, hey, here's the pill. It can take care of these periods and you'll have better skin. I did have good skin. I didn't have acne.

But they were like, oh, you will never have acne. And like, here's the promise. No informed consent. No, like, hey, you could be at risk for strokes, depression, like any of the things that's in the package insert. This is really where Beyond the Pill was born out of, is that so many of us don't get the informed consent.

Now the ironic part of me writing Beyond the Pill is I talked at nausea, maybe, about how so many women are put on the pill for painful periods, for irregular periods, for acne, for all these signs and symptoms that are actually underlying issues. Now what's ironic is that 29 years later I'm that person.

I was put on the pill to cover up these painful, heavy periods, and it wasn't until I was diagnosed with secondary infertility, and it wasn't until actually an incidental MRI, that it was discovered [00:06:00] that I have endometriosis. So, yeah, I didn't write that book expecting it was going to be about me, but lo and behold.

I'm her. I'm that person. Um, so if you don't know, roughly 60 percent of women who are given the pill are not taking it primarily for pregnancy prevention. They're taking it for symptom management. You have the right to use whatever you need to get out of pain, to function in your life, and if that's the pill, then you do you.

I don't judge you. But I will judge your doctor if they're lazy and they don't do anything except pass you the pill and tell you, like, this is the best that we have, goodbye. Bye. Because referrals are not happening that need to happen. So that was my story. Put on the pill, did it for a decade, came off because I was like not even sexually active and I was, I also was just like, it was the moment that I was sitting in med school and they were like, a woman can only get pregnant one day out of the month and I was like, Stop everything.

What? Why am I taking this medication every single day that makes me feel awful because I [00:07:00] was one of those people that had significant depression, uh, repeat yeast infections, no libido, like I'm in my 20s and I'm just like, don't look at me, don't touch me, I don't even care. Um, I had side effects so it's like I'm getting off of this.

Lo and behold, I get off of it. I lose my period and when I finally get it back, it's raging. It's, it's just like it was when I was a teen. I did a lot, nutrition, lifestyle wise, to make my periods manageable, which was awesome for living and thriving, and I did have two kids. However, I also, uh, made it so that it was harder to detect endometriosis.

So, I, fast forward, and I'm told that my secondary infertility is because I'm old. Like, they did all the blood work, nobody checked me for endometriosis, which you cannot check via blood work. Um, at least, I mean, there is a CA 125 that you can check, but that's not going to be definitive. The, the best steps are [00:08:00] trans, vaginal ultrasound, a gel MRI for deep endomapping.

And if things are seen there, then going for laparoscopy excision surgery, if that's what you need. Um, the only definitive way to really know is when you excise that surgery and you, you do the pathology, but you may not even need that. So anyhow, uh, yeah, as it turns out my third egg retrieval because I go through IVF being told my eggs are old except that I have like, lots of eggs.

My AMH is, um, my last one was 2. 5 at 43. I, like, I'll be 44 in two months. That's amazing. My ovarian reserve is amazing. So that's just all to say, it was not any of this stuff. I let people convince me I was old. Science and medicine, it's like what I've been taught, is that at my age I would be old. No matter me having a baby at 40.

Anyhow, I get, Prunovo reaches out to me, an MRI company, they do full body MRIs, incidentally they find an [00:09:00] endometrioma and adenomyosis and then begins the journey of endometriosis. So I have lots of protocols to stay out of pain, to avoid excision surgery if you don't need it, because does everyone need excision surgery for endometriosis?

No. Will everyone feel better if they have it? No. This has to be very individualized. So, if I didn't want to have another baby, I would not do this excision surgery because honestly, I don't have enough pain. I do have enough fatigue and other things going on to warrant it. It makes sense that like, on the ligaments of where the endometriosis is in my body, like the kind of pain that I do have, but it's not too much.

debilitating. It's not enough to rush me to surgery by any means. Um, this is more about I need to drop the inflammation in my body. I also have a fear because any, you know, having an endometrioma, that And I have bilateral [00:10:00] endometriomas that can increase your risk of ovarian cancer. So, whereas the general population might be like more than 1%, the woman with an endometrioma might be more like 2%, sometimes more.

I do have a family history of an aunt who had ovarian cancer, so this is something that I'm like, I need to do everything to decrease my risk, which starts with with nutrition and lifestyle and excision surgery is an option and all of that. So I'm doing this podcast today. That was like my quick version of everything going on, which didn't feel very quick, so I apologize.

But, uh, but I'm doing this podcast so that if you choose to go the route of excision surgery, because it may get you out of pain, because it may put a baby in your arms, which is not something that I take lightly having had several miscarriages failed embryo transfers. Um, so I, I just want, I know sometimes I see people online that are just like, oh, just take NAC and melatonin and try to have a baby.

[00:11:00] I take NAC and melatonin. Um, love it. It's great for endometriosis. Did not get me to a baby. Okay, so, uh, what is true for you? That's what I want you to be asking yourself in this podcast, in every podcast episode I do, and every time you come across somebody on social media, on the internet, or you sit in a doctor's office.

You know your body. Sit through the lens of what's true for you. And I will say this, if you're gonna go for excision surgery, please consult at least three doctors. Doctors. Three surgeons first. You're running, it's like, I'm gonna get some hate for this. I don't even care, because I'm looking out for you, and you're the only person I care about here.

So if doctors want to come and they want to hate on me, they can just jog on. If your doctor is just a run of the mill general OB GYN, oh my god, great for pap smears, great for your physical exam, great for so many things, but not excision surgery. Don't mess around with this. Excision surgery, can result in more adhesions and more pain if not done right.

You want to have one and done if you [00:12:00] can. You want to have a surgeon so good that they're going to get everything they can in there so you don't have to have surgery again in the future. So I can put a few of the doctors that I would recommend in my show notes that you consider consulting with if you have endometriosis.

You've had excision surgery and you're like, this surgeon was the best. I sing their praise everywhere. Please share that. Drop it in. You can leave a comment. I read all of the comments on the podcast, so you can leave it there. You can leave it on YouTube. You can leave it on my social media, like wherever you are consuming this.

Please share that information, because word of mouth is one of the best ways to find a surgeon. It really is. All right, so if you're considering going into excision surgery, you're going to screen your practitioners. You, I'm going to give you this other tip. If they don't want an MRI, like a deep endomapping MRI, and they're not doing the Enzian score, I don't know that I would go with [00:13:00] them, okay, because you don't want your surgeon being surprised at what they find.

There will always be some surprises when they get in there, okay? Because you cannot see everything on an MRI. But the MRI can give them a really good idea to help them give you a better informed consent. So, telling you that like, yeah, your lesions, they look like they might be infiltrating your bowels.

If that's the case, we might have to do a bowel resection. This is what life will look like after surgery. This is what the procedure, this is how long it's going to take, how long you're going to be in the hospital. You should have all that information. And in fact, um, I am going to put a link in the show notes.

You can go to drbrayton. com slash endometriosis and you can download my post op, uh, plan that I put together because honestly, Um, I saw several doctors. I wasn't satisfied with their post op. I was like, this is not detailed enough. So I put my own uh together Talking through all the ways to take care of yourself post op.[00:14:00] 

Um, I think that'll do a podcast episode about like what worked What didn't work? Um for me and talk about that pretty candidly and then um, but i'm gonna give you that That is a resource and in fact everything that I talk about today I'm gonna just go ahead and put that in a pdf guide for you as well For um how to prep for this as well, so you can just download that and have that as well Um, and i'm just gonna make a whole bundle for you as i'm sitting here talking I'm, just like I got I wish that instead of spending So much time on this from the patient perspective having to do this Like someone had just handed me all this stuff.

So i'm gonna do that I'm going to do that for you. Okay. Very first thing I want to talk about. So we're going to get into nutrition. Your nutrition absolutely matters. If a surgeon tells you it doesn't matter except for the bowel prep, just moonwalk right out that door. Just don't, just don't because it absolutely matters.

So when it comes to nutrition, here are the goals. So number one is. We want to decrease inflammation. So we [00:15:00] want to start dropping inflammation. Endometriosis is a systemic inflammatory condition. That means it's not just locked down in the lady parts. It is throughout your entire body, which is why you're going to brain fog, fatigue, anxiety, and depression.

mental health issues arising, it's not just from pain, it's that inflammation disrupts neurotransmitters in your brain. You can feel this in your joints. When I'm having an endoflare, like my poor little fingers can't even type, like I'm sure that if you have endometriosis, you can relate to some of what I'm saying here.

So goal number one, we want to drop inflammation. Goal number two, we want to support immune function. You are going to be in a healing phase, right? A significant healing phase when you go through surgery. You don't want an infection, but you also don't want an immune system running amok. I, I have concern about how my body's going to act with these sutures because when I had my second child and I had to have sutures, hmm, my immune system [00:16:00] was really really mad at that site for like a very long time.

Um, so, and that, so you know, I also have a couple of autoimmune conditions. So my immune system, it's kind of like loves to misbehave. It's a little troublemaker. And just, you know, my personality is kind of a troublemaker. If you haven't caught on already in this podcast, um, calling out doctors. Okay, so the third goal.

is we want to improve gut health for recovery. So your gut is the seat of your immune system. So if we can effectively improve your gut health, we can improve your immune function and your inflammation as well. But your gut, we want to keep healthy because we want. a nutrient dense diet. But we also, as you know, I said this in Beyond the Pill, you're not what you eat, you're what you absorb.

It's a very common saying in naturopathic medicine. That's where I heard it first. Functional medicine doctors also say it as well, is if your gut's not healthy, you don't have adequate stomach acid, your [00:17:00] little villi in your small intestine aren't ready to absorb things, like we, we can have issues with getting our nutrition up.

Okay, so we want to eat an anti inflammatory. diet and that feels kind of daunting but I am not the type of person who likes to focus on what we take away I'm the kind of person who wants to focus on what we bring in So I want you to start bringing in more fish cold water fish specifically. So You know this podcast again.

I want you to think about what's true for you This is what I've started doing. Um, this may not be right for you given certain medical conditions. Remember I'm a doctor not your doctor So consult your doctor about what is best for you. Now with fish I I have canned salmon because if you follow me on social media, you know, I'm like obsessed with salmon salad Um, I can get I definitely can get into like food obsessed where I just want to eat like the same thing all the time Salmon salad.

I'm like, that's that's a [00:18:00] pass. You can eat that all the time It's gonna be fine. So I've been eating a lot more salmon. I have, um, sardines, mackerel, um, anchovies, all of these are really great as well for omega 3 fatty acids, for selenium, for iodine. I have given myself permission just to eat salmon and none, not any of that other stuff because I'm like, look, surgery's going to be hard enough and you hate that other food, like, you just give yourself a little break here.

So eating cold water fish, we want to start bringing that up and that's going to be one way to start achieving more quality. We've got to front load the protein and the strength training because after the surgery you're not going to be able to lift weights from anywhere from 4 to 12 weeks depending on how extensive it is.

I'm in my 40s. Um, In four weeks, I'm gonna lose a lot of muscle. I'm kind of pissed about that right now because it's so hard to get it back. It's so hard at my age. [00:19:00] And this is where I'm like, oh my god, it would have been so much better if I had this surgery in my 20s. I would recover so much faster. All these things.

But you know. Like, judging myself on the past will not move me forward into the future. Okay, so, fatty fish, leafy greens. We want to be eating leafy greens. These are going to be great sources of minerals and antioxidants. So, if you can bring in arugula, um, you want to have cooked broccoli, cauliflower. All of this is happening.

You're starting this, so I should have said this first. I'm so sorry. four weeks before the surgery is ideally when you start all of this. Because as you get closer to the surgery, within the day or two of the surgery, like, cruciferous vegetables you want to have out because they could cause gas and bloating.

And, um, if you don't know, they're gonna fill your abdomen with, uh, CO2 when they do this surgery. And you're gonna be, like, bloated. And they're gonna give you meds that are gonna be, like, they're gonna, They bloat it and [00:20:00] they're going to extend your abdomen and then they're going to give you meds that are going to slow down your bowels and like there's just a lot going on already for those bowels.

So leafy green vegetables, swiss chard, rainbow chard, um, you can, uh, so arugula, I brought that up because that's a cruciferous vegetable in with the broccoli and the cauliflower, brussel sprouts, um, looking at spinach as a, so spinach has iron, it's certainly not like the most popular bioavailable source of iron, but we want to start building up iron rich foods.

Um, you know, people will also say like, well, lentils aren't a great source of iron either, but, but you are getting iron from that and it has fiber and it has a bit of protein and you do need carbohydrates as well. So when we look at those leafy green vegetables, berries. This is something I don't care if it's the dead of winter.

Try to get berries, even if they're frozen. So the fresher the, the produce, the more vitamin C. Vitamin C is an antioxidant. [00:21:00] So as it gets cooked, cut, even frozen, the vitamin C can start to degrade. So fresh is definitely better, but if you gotta go frozen, go frozen. For the vitamin C sake, you can also always add in like citrus fruits, which are great in the winter.

But berries are going to be a source of vitamin C, antioxidants, polyphenols that are going to support your gut health, and fiber. So I've actually just been like eating handfuls of raspberries. Also, I've been eating dark cherries as well. That's helped support melatonin and They're anti inflammatory. So starting to bring in more fruits and vegetables is really the takeaway here.

Uh, but I want you to be really mindful that you're getting variety as well, because that helps the microbiome.

Now nuts and seeds, like chia seeds, I eat those most days of the week. Um, my breakfast, if I'm having like [00:22:00] a Greek yogurt, I will do chia seeds. fresh ground flax seeds. If I'm in that part, if I'm in the follicular phase when I'm seed cycling, um, I will bring in psyllium husk. So different fibers to give the microbiome some support and to keep the bowels moving.

So walnuts can also be great, cashews. However, as you get closer to surgery, depending on what's going to happen for you, um, You want to follow the bowel protocol, which may say no nuts and seeds, like a week before surgery and even the weeks after surgery. So it all just depends on how extensive your surgery is.

You got to individualize this to yourself.

Okay, I mentioned protein intake. So there's the muscle mass loss that's going to happen. Not looking forward to that, but also What are you made of? You're made of protein, so if you're trying to heal [00:23:00] tissues, we have to be consuming more protein. Now, before going into surgery, I am trying to get closer to 2 grams.

So before surgery, I'm trying to get closer to 2 grams per kilogram of body weight every day of protein. Um, so if you've heard me at, you know, in the perimenopause podcast, I talk about doing 30 grams of protein at every single meal as a minimum is even more than that. And I'm supplementing with protein powder drinks.

I'm drinking, um, so I'm drinking protein powder drinks. There's yogurt drinks. I'm. that don't have added sugar, but I'm not a fan of like how much sugar is actually in it. But I'm like, you know, you're, the goal here is to get more protein in the system. I always add collagen to my coffee and I'm drinking, I've been drinking Ensure.

Oh, I don't like that. It's like, first time I drank it my gut was like, mmm, this is funky. We don't like this. [00:24:00] But there has been research showing that That if you consume things like Ensure, it doesn't have to be that brand. You know, there's other enteral drinks that have lots of vitamins and minerals and nutrients in them.

Um, but consuming those like two to three times a day, I'm not doing that much. I'll just be honest. I'm doing like one or two a day and then got like a yogurt drink that's like 20 grams of protein that I drink and then another protein drink that's like 20 grams of protein that I'm doing, um, but I just want to say that there has been research showing that the drinks that are like Ensure, um, that they do, people who consume those before surgery, especially like the week before, do have better post op outcomes.

So while I'm not totally a fan of The way I would formulate it differently, um, I don't know if I have time to make a drink like that, but maybe I'll do that in some time, but like, if I, I would formulate it differently, um, not like a really big fan, and they're just [00:25:00] so sweet, it just really knocks me, I, I'm not like a sweet food kind of person, um, and then Organi is another company, they do, um, me.

So this, they do like a vegan protein, they have drinks, and they believe they have about 20 grams of protein in them. I'm drinking that as well because it does have added nutrients to it. I'm just trying to get my nutrients stores like, just like, over the tippy top. I'm not worried about any excess nutrients coming in and ending up with toxicity because this is a very short window of time.

Um, but I honestly, I will say that. You know, if you're vegan, you can go that route. If you're vegetarian, you can go that route. If you are not, I do think animal protein is going to be much better quality. And when we talk about protein, and what I mean by much better quality is the amino acid profile is there.

It's a per it's you eat meat to rebuild your meat. I know that's probably cringe to say, but like if that [00:26:00] makes sense to you that like you should Be wanting the same amino acid profile as muscle tissue if you're going to build muscle tissue, but I respect your diet Okay, so don't come for me in the comments if you're like, I can't believe you talk about eating meat Um, it was actually a conversation side side note here at our dinner table last night with my kids where, um, my son was saying, like, in his video game, he has pet ducks.

So he's like, I'm never gonna eat ducks again because, like, I feel this way about them. I'm like, okay, fair. And I was like, I feel that way about cows, honestly. Like, I feel like it's, I'm like, I love cows and I'm so torn. And also, as somebody who's a vegetarian for 10 years and who's experimented in veganism, like, My body needs meat and that I have to respect that about myself.

So, um, I just share that because sometimes people are like, you're so heartless and I'm like, no, I totally feel guilty sometimes eating a hamburger and I'm just like, I just really am so grateful to this cow who gave its life so I could sustain my life. Anyhow, I'm taking it like that's a tangent. Okay.[00:27:00] 

All right. What I do want to say though is that endometriosis tends to, uh, have a buddy riding shotgun, which is iron deficiency anemia. from the heavy periods. I don't have iron deficiency anemia. I had a full blood panel done. I checked all my nutrients. I'm good. But still it's a wise idea. You don't know what the blood loss is gonna be to make sure that you're consuming iron rich foods.

We talked about lentils. We talked about spinach. Um, also red meat, of course, like, You're not gonna beat that. It's gonna be the best iron source. Can you eat organ meats? Oh my god. You're like, you're winning. You're winning there, but understand that, you know, these, so when you eat meat as well, it's also going to be bringing in other nutrients to help you build your red blood cells, and we want to be doing that.

So, namely, we want to be looking at iron, B12, B6, and folate. So, I'm gonna ju I'm just jumping ahead of myself, but, um, I'm taking my prenatal plus from Dr. Brighton [00:28:00] Essentials on top of everything that I'm doing, because one, hoping I get to a baby soon, but two, it is formulated to be very nutrient dense, and it has an absorbable, non constipating form of iron, and I really want to make sure that I don't end up anemic at any point because then you're really fatigued and you're really struggling to heal.

Now just going back to protein sources, we talked about the fish, we talked about meat, you're going to be eating tofu, I talked about all the beverages that I'm um doing, but don't forget eggs. Eggs are awesome because eating the egg yolk specifically, so white's going to be protein, The egg yolk is going to be rich in vitamin A.

Vitamin A is another one of those nutrients that we need for healing our tissue but also helping our immune system. You're also going to find the, uh, vitamin A in those dark leafy green vegetables. You're going to find it in carrots, sweet potatoes, so those carotenoids. It's not [00:29:00] the active form of vitamin A like you're going to get in liver or egg or other animal proteins that have vitamin A, like the fat of chicken.

That's why chicken soup helps as part of healing. Definitely going to be part of my post protocol. Uh, but you know, with that vitamin A being in the carotenoids, your liver will convert it into the vitamin A that you need. So the beta carotene becomes that vitamin A and it's a beautiful mechanism where your body will regulate that toxicity.

Now, the foods I've already given you are great sources of fiber, so the lentils that we talked about, the leafy greens, the berries, but we also want to be looking at complex carbohydrates as well. So, in an anti inflammatory diet, sometimes people have you avoid oats or they have you have only gluten free oats or gluten free organs.

Organic oats, so the oats can be a really great source of fiber and really beneficial for gut health But again, [00:30:00] this is a what's true for you. What works for you because it might not work for you

Now let's not forget our friend avocados. Avocados are a great source of vitamin b6, which I told you is all about building up that blood, but I mean it's also going to support your estrogen and progesterone, and it's a great source of fiber as well, and having those healthy fats come in is important. I am going to be dialing back dairy the day before my surgery happens.

I'm actually, so I don't have to do a bowel prep, um, but I'm still gonna mostly adhere to a clear, not clear foods, but more of a liquid foods diet the day before my surgery. And the reason for that is, is that I just know my digestive tract and I know how finicky it can be. I am doing everything to take care of it, to feed it the way that it needs, but I just want to give it like a little bit of a rest for the day before and then probably [00:31:00] to the, the day of surgery and then the day after.

So two days after the first day is what I was trying to say. Okay, that's all kind of confusing. Let's cut that out. I'm gonna go. So I'm gonna give my gut a bit of a rest for three days. That's going to be the day before surgery, the day of, and the day after of doing just, you know, there's going to be liquids and there's going to be smoothies, but then it'll also be like broths.

I will cook like the carrots and celery and, you know, just basically blend them up in the broth to drink that. So there's still some fibers there, but so that my gut doesn't have to work to try to digest it as much.

Hydration is a must. Okay, for anything else making the IV line easy to set, finding your veins, making them nice and plump and juicy, but you really want to hydrate. I drink about [00:32:00] three liters a day. So I start with three In the morning, drinking electrolytes. I prefer Element. It's what I like. It's palatable.

I like the profile of the minerals that are in there. So that's what I start my day with is drinking that. I am also bringing on coconut water. Coconut water is another great source of electrolytes. For me, Little TMI, but it helps move my bowels. So I've already got it stocked for after the surgery. Um, because Just I want to just say like any like Anybody who's ever had abdominal surgery or an eight retrieval or anything happening in that area knows constipation makes it all worse You ever had a baby?

Constipation makes it all worse. So we want to keep those bowels moving So that's going to be part of the hydration piece as well.

Is there anything else I'm doing? [00:33:00] I don't know Is there anything else I'm doing? You're not listening

All right, just sit over there with your headphones being cute. Okay.

Bringing in additional anti inflammatory, so like turmeric and ginger can also be really beneficial. So, you know, buying pre made shots can be really expensive. I don't know. I just am always somebody who's like, If I can make it myself, then I'll just do it. So I am blending up turmeric, ginger, lemon juice.

Yes, it's gonna degrade. That vitamin C is gonna degrade because it's gonna sit, but I'm not gonna be up for this once I am, um, once I've gone through surgery. So, and then I add water to it and I just blend that whole thing up and I usually throw in like oranges or green apple, something to [00:34:00] sweeten it up because it's, it's potent.

It was a lot. Um, and then I strain it and I put it in bottles for storage and I'll be drinking that. I, well, I am drinking that and then I'll be adding more of that post, post op as well into the routine because that's gonna help. my gut. It's also going to help with modulating inflammation as well. We don't want to kill all the inflammation.

We don't want to squash it all. We need inflammation. It's an important part of the healing process. But like I said, I don't want my inflammation getting so crazy that I feel absolutely awful.

Okay, life. Let me do that. Okay, lifestyle wise. I was not prepared for how I would feel going into this. It's been kind of a shock where I'm like um, crying, crying about like, Oh, god I don't want scars on my belly. Crying. [00:35:00] Like uh, endometriosis underscore surgeon on Instagram. Great account for seeing surgeries, what's going to go on.

Um, can't watchI can't watch them right now. Like I've recommended them, I've shared them, I can't watch them because I, the, the Like, ugh, the thought of someone inside my body with the instruments and, ugh, it's giving me the heebie jeebies, like, I did not expect that. Especially because, like, they're gonna have to, like, be around my ligaments and my nerves.

Ugh, it makes me, like, so squeamish to, like, think about it being done on me. And I say this as somebody who's, like, I've dissected cadavers. I've dissected a lot of things. I used to run a biology lab, um, when I was getting my master's. Like, oh my god, um, I've dissected a lot of stuff. And, uh, never ever have I had an issue.

But, oh my god, now that I'm facing this is being done to me, this is like making me squeamish. So, um, you know, it's the countdown. I'm having, I go into the hospital in two days to be admitted. Um, it was three days prior. So four days total before my [00:36:00] surgery that all of this really started hitting me and I did not expect this and I've not heard anyone talk about this.

Um, well, this is why I'm still like chickening out. I'm like, I don't know if I really want to do this. Um, I really wish that I had somebody to In the mental health arena, who understood endometriosis. I don't, I'm sure, I know these people exist. But yeah, I just haven't put one on my team, and I regret that right now.

So, you know, it is something, I just think it's important to have someone to talk to. I also think it's important to start working on stress, if you haven't already. So again, remember, we're trying to start this four weeks before, but even if it's four days before, like meditate, meditate. Do yoga, like deep breathing, like whatever it takes, binaural beats for you to start bringing down your stress levels.

Stress. results in bad outcomes, which only makes you feel more stressed. But also a positive mindset results in positive outcomes. [00:37:00] So I've actually, um, recorded some affirmations of things. Me talking to myself being like, your body's beautiful, it's strong, it is capable of healing, it is designed to like, you know, recover and you know, just like things along those lines.

It actually doesn't start with it's beautiful, but it's actually because I was like thinking about the scars that I'm like, I need to put that in there. I need to say that. Um, so yes, whatever you can do to start bringing down your stress, surgery is stressful in itself. And so start something now that you can continue on.

And maybe it's just you record your own little affirmations or you listen to an affirmation app. You take that to the hospital with you. You put in your earbuds and you listen to that. By the way, charge all of your stuff before you go to the hospital, and bring all of your chargers with you. I have um, I have like these bricks that you can put like, USB, you can put all kinds of things in.

I can probably put them on Amazon. Yeah, I can put them on [00:38:00] Amazon. I'll put a link in the show notes of like, here's these things that I'm taking to the hospital just to like, make it easier to be in there and make sure that all my stuff is charged. Sleep. This is something that we would tell somebody, like, in any major life event that is coming, right?

Like if it's childbirth, if it's running a marathon, whatever it is, get your sleep now. So, I don't need to, I'm kind of perturbed that I have to go, my surgery is at 5 a. m. and they're like, you have to come to the hospital the night before. I'm like, great, so I'm not gonna sleep. And then they're like, oh yeah, and you might have to stay the extra night.

I'm like, great, so I'm not gonna sleep again. Like, um, and they're like, no, it's gonna be great. We're gonna make you comfortable. I'm like, do you have fluorescent lights? We're Yes, okay, so if your big lights are on, I'm not gonna sleep, I'm gonna be irritated, I'm not gonna be a nice person if you're waking me up at like 2 or 3 o'clock in the morning to do stuff, like I apologize in advance to my team because, yeah, but also like, hospitals are foreign and they're cold and they're like, icky sometimes, the vibe of a [00:39:00] hospital, you know?

And so, um, this is why it's so important to sleep now. And, um, and in case you're just like wondering, like, how are you a doctor and you're saying that about a hospital, I literally had home births because I do not like to be in hospitals. I don't like, if I'm the patient, I don't want to be in the hospital.

Like, come to my house and let's do everything, guys. No, you can't do that with a surgery. So, anyhow, 7 to 9 hours. Now, start getting it now. Seven is too little for most women. This research of seven to nine hours is actually based on men. In reality, your minimum's more like eight and you're, you're probably gonna do better at nine or ten.

Especially as you prep for surgery. So if it means taking melatonin at night, which by the way, I take melatonin, uh, not for sleep, but actually for endometriosis because it's an antioxidant. It's been shown to be very beneficial. Um, it's also great for egg quality. So with that, if you need to take melatonin, [00:40:00] Take that.

I'm also taking my Adrenocalm supplement, which has L theanine in it, uh, which is like such a great amino acid for like calming your mind. It has facetylserine for dropping cortisol. Passionflower, which helps GABA stimulation in the brain. That's how we stay asleep at night. So I'm also taking that. So because I'm like, I just have to ensure I get the best sleep.

Despite having two kids.

Exercise wise, there's a lot of people who will say you need to dial back before you go into surgery. And I've seen people say like one to two weeks before surgery, it should just be like really gentle, really relaxing. I am lifting weights. I am lifting weights. I will hit it through like, this is my routine.

Okay. I'm not starting a new routine. Three times a week. I will hit that this week. I am walking. I am doing all the things to support my muscle mass to support my health But also because I will go [00:41:00] crazy Like every time I have an angry retrieval my doctor He like sends me these funny little memes about what a baby I am because i'm just like I can't lay here anymore I need to get up I will keep stay tuned.

I'll tell you how post op goes for me. Um, but I am lifting weights Um And, but I am lifting weights. Your doctor may tell you one to two weeks before surgery, avoid strenuous activity or really heavy weights. If that's what they're saying, it's because that's what in the individualized information that you need to be receiving.

Okay. I'm not like power lifting. I'm not maxing out, but I am still just challenging my muscles and reminding them that I need them. Don't go away. I'm talking to them. I'm talking to them every day. Okay. Okay, the week before surgery, you got to stop alcohol. You got to stop anything that could thin your blood.

So, alcohol has to [00:42:00] go. Um, better if you do it a month before, because your liver is going to have to also process all of the anesthesia, all the meds going on. And in addition, with alcohol, it can raise estrogen levels, which is problematic for endometriosis. I hate to be the one to tell you, but like, just Alcohol is not great for our hormones and not great for our bodies.

If you're a smoker, please stop, like, immediately. Like, never. And that goes for vaping as well. And if it's cannabis and it's combustible, that means it's smoke. Mm mm. Stop that. Stop. That is too much free radical damage happening to your cells. Okay? Your doctor's probably gonna tell you at least four weeks before you need to quit smoking.

I will just tell you that, like, as you're listening to this podcast in 2025, You, you know, you know smoking's not good for your health. We don't need to finger wag you, okay? But before surgery it's got to stop. [00:43:00] Okay, so let's talk about supplements now. So supplements, we want to be getting inflammation down.

We want to be building our nutrient stores. We want to be bringing on things that help us have healthy red blood cells. We want to be making sure that we've got everything our body needs to heal and it's taking care of our immune system. Vitamin D3 is something that is a must. In my opinion, your doctor might have a different opinion.

It might be different for your body. We always want to check blood values. If they're below 50, we probably want to bring on a supplement. Some doctors let you go as low as 20. That's really low. Okay, so ideally we want to be above 50. I am taking, so Dr. Brighten Essentials has a vitamin D3, it's coupled with K2, it needs to be coupled with K2 so that calcium ends up in your bones and not your blood.

Vitamin D3 can be so positive for the immune system. [00:44:00] I am currently taking 4, 000 IUs of it a day. That's what's right for me. Yours might be 2, 000 IUs a day. It might be 5, 000 IUs a day. Your doctor should run these labs and really guide you in that.

Now, I've been taking omega 3 fatty acids, but I have stopped because I'm within the week of going into my surgery. I was only taking 3, 000 milligrams. It could potentially be a blood thinner. As somebody who's been on higher doses, and had my blood tested for my clotting time. It's not been an issue.

However, this is true for me. I do have a gene mutation for a clotting disorder. And so, this is going to look different for me than what it's going to look like for someone who doesn't have that. But all of us should not take omega 3 fatty acids that week before the surgery. I'll be [00:45:00] back on them.

Probably, I'm thinking five to seven days post surgery because I'm gonna be on blood thinners. I'm gonna be on a low molecular weight heparin. It's called Nenoxaparina here. It's Lovenox in the United States. They're not sponsors. This is just what I have to do because I'm Definitely afraid of a clot. Uh, so I'll be wearing compression stockings.

Um, we got compression socks. They'll put them on me during surgery. I'll wear them afterwards. I'll wear them probably for a week. I'm gonna get up and walk. Every hour, if I can just get up every, like, for five minutes, I've got, um, my Apple Watch, which will remind me. It's like seriously so annoying sometimes though.

Last night I sat down to eat dinner and it was like, you need to stand. And I'm like, I was literally in the kitchen. Like, what, what do you mean I need to stand? Anyhow, I digress. So, uh, going back to the supplements. So we talked about omega 3 fatty acids. These are anti inflammatory. They can be really, really helpful for [00:46:00] endometriosis.

They're just really helpful overall in terms of your mental health and your immune system health.

Now, I talked about eating vitamin C rich foods. I'm also supplementing with vitamin C. I'm taking a thousand milligrams three times a day of vitamin C. I want to make sure that I've got everything to rebuild that collagen and, uh, afterwards I will, I may up my vitamin C, so I have magnesium citrate ready to go, uh, in case I do have some constipation, I will take that.

Vitamin C can also loosen up the stools as well, and so I am considering increasing that dose. We'll just see how everything goes.

Zinc is another one that I'm bringing in. So, again, I'm taking my prenatal plus that has zinc in it, that has all the B vitamins and the iron to rebuild my [00:47:00] red blood cells. It has just a ton of nutrients like vitamin E, which you want vitamin E when you're taking vitamin C because they work together as antioxidants.

So, little nerd moment. Vitamin C is water soluble. It sits in the aqueous layer of the cell. Vitamin E is in the lipid bilayer, so you've literally got like this little lipid bilayer around your cell. And when a free radical hits it, vitamin E donates an electron. Vitamin C comes in and says, Here you go, you can have mine.

I'll take care of you, vitamin E. So that helps with oxidative stress. And When your immune system gets activated, we have an increase in oxidative stress, because part of how the immune system works is creating these free radicals to battle bacteria, viruses, things that we don't want living in the wrong parts of our body, or in the wrong amounts of our body.

So in addition to the prenatal, I'm taking 15 milligrams [00:48:00] of zinc. My prenatal has copper in it, which helps balance zinc and copper. This is going to be a short period of time, so I'm not going to take it for a long period of time. Um, if I was, I would be very much, if I was, I would be really mindful of the copper balance with that.

Now vitamin A is also in my prenatal plus, and that's a combination of the beta carotene and active vitamin A, because not everybody has the genes to effectively activate that vitamin A. Um, we keep it at a lower dose because in pregnancy you don't want high dose vitamin A. I am bringing on additional vitamin A.

as a supplement and I'm going to be aiming for about 5, 000 IUs of vitamin A in addition to what's in the prenatal and that's only going to be for about four weeks, maybe six weeks, um, total from the [00:49:00] start. So I started this a couple weeks ago and then I will continue it a couple weeks post op, um, just to support my immune system and that tissue healing.

Depending on how I feel, how things are going, I might continue it longer.

Now I told you I'm drinking collagen in my coffee every day. Coffee's gonna go, post op, coffee's gotta go, um, just because it can be irritating. Uh, so I'm going to be keeping up the collagen. The collagen is about 20 grams a day that I'm doing and so on top of the protein intake, I also bring in the collagen and that's to support tissue healing.

I am taking probiotics currently. And I will continue those post op as well, so I'm taking our women's probiotic along with Saccharomyces bullardii. So the women's probiotic, that has a [00:50:00] combination of lactobacillus, which we need for all parts of our body. The, uh, lactobacillus content of the gut is pretty reflective of the lactobacillus content of your vagina.

There is, um, Maybe this is news to you, uh, and it might sound icky, but your gut and your vagina, they share bacteria, um, and there can actually be a migration across the perineum. And so we need to make sure our gut is healthy if we want to keep our vagina healthy. When antibiotics come into play, they start knocking down good guys.

The probiotic also has bifidobacterium in it. The probiotic also has spore based organism in it. The probiotic also has spore based organisms in it and that helps keep, it's basically, they're like bouncers in the club. So if anyone's getting rowdy, it helps keep everybody in check. And then it has antioxidants and pre, and it also has antioxidants and prebiotics.

[00:51:00] The antioxidants are specifically ones that have been studied for urinary tract health. I don't want a UTI. So, well, I'm keeping that on lock. And then the Saccharomyces boulardii, that's a yeast and it's been shown in the research to raise secretory IgA. Secretory IgA is a specific immunoglobulin that grabs on to stuff in your gut that ought not be there.

And so, uh, it's a, it's going to help my gut health. It's also going to help my my immune system.

Now I talked a little bit about what I'm taking for sleep. The other thing I'm taking is magnesium glycinate and I'm taking 300 milligrams every night. I always get headaches after I go under and it doesn't matter how much water I drink, it doesn't matter like if I eat, like it just doesn't matter but it has mattered with the magnesium.

It's dulled the headaches that I get anytime I go [00:52:00] into sleep. Uh, general anesthesia and, uh, it's also helping me stay calm. Uh, I think I would freak out a lot more if I didn't have magnesium aiding me.

And magnesium, along with the cruciferous vegetables, along with the amino acids, the B vitamins we talked about, all of those support liver detoxification, which we want to be at its best for our hormones always, but also because, again, there's going to be medications that your liver has to process. So we want to give it.

Like, the best leg up for that. I am also taking glutathione, and I'm taking a liquid glutathione, and the reason for that is that I, and I already said I was taking NAC as well, so I guess I should say that. Okay, so I take NAC, about 600 milligrams, which is a precursor to glutathione. It also helps with liver detoxification.

It's been shown to be beneficial for those with endometriosis. And I'm taking [00:53:00] glutathione, which is a really, really potent antioxidant. I want to make sure I'm supporting my liver health, but again, I want to make sure that the oxidative stress doesn't get the best of me.

Okay, now before your surgery, I told you no omega 3 fatty acids. Vitamin E is something else you don't want to have in high amounts. Like I said, I'm just taking what's in my prenatal. That's not a high amount. Ginkgo biloba is another thing that if you have that in any of your supplements, that can cause blood thinning depending on the dose.

And if you're supplementing with garlic, that can also do it. Um, so if you're taking any supplements that are meant to help with cardiovascular health, make sure there's no blood thinners in it. And go over your list of supplements with your doctor to make sure that they're okay with everything that you're taking because there may be a drug and nutrient interaction that you don't know about.

You can also Google this. It does exist online where, like, [00:54:00] there's drug nutrient interaction calculators out there, like, you can input it and you can look at it, um, and that can sometimes be helpful because sometimes your doctor might say, I don't know. I wasn't trained in nutrition. I don't know anything about supplements because I was never trained in that.

So, um, you know, and when in doubt, this, I would cut it out. Uh, I would also say, You know,

okay, there's more supplements that I'm taking than just this that are not specific to this procedure. So I'm taking CoQ10, L carnitine, um, taking, um,

I'm taking alpha lipoic acid,

I have adrenal support, like I, I have my mix of things that keeps and has kept my autoimmunity antibodies in check, my endometriosis symptoms in check, and [00:55:00] they're part of a fertility protocol. That's all just to say that, um, your protocol may not look exactly like mine and I hope that you are able to pick and choose from this what is best for you and take that with your provider and to have a conversation with them.

Now I alluded to before that if you need to have bowel prep, make sure that you talk to your doctor about that. What would the bowel prep look like for you? Talk to them about medications that you are on right now. So, if you're on things like aspirin, right, we talked about blood thinners, stop that. 7 to 10 days is usually what's recommended before going into surgery.

But again, talk to your doctor about that. Because if you've got a whole list of clotting factors, they may be like, you know, uh, let's just like, let's switch things up. Um, and let's do some things differently. Instead of these medications you're on, let's swap these out with other things.[00:56:00] 

Okay, so that has covered the nutrition, lifestyle, supplements. I want to come back to the emotional preparation and just like harp on that for a minute if I can.

If you're someone who's prone to anxiety, like I'm prone to anxiety, then the unknown is the freakiest scariest thing. It's worse than a monster under the bed kind of situation. Make a list of questions. Ask them and ask them and ask them. I don't even care if you annoy your doctor. I'm pretty sure I'm annoying my doctor right now, but like if things are not crystal clear for me and I exactly know what to anticipate or what to prep or, uh, what's gonna happen.

Like, I asked for a timeline from my doctor. Like, you're, you say surgeries is 5am. Talk me through what that's gonna look like. What can I expect in the morning? When can I expect to be out of surgery? Knowing that these things are ish, right? It's like, an hour ish. Um, you know, when, when can my family come and see [00:57:00] me?

Like, when can I be discharged? When can I eat? When, when everything, right? Go through the timeline. Ask all the questions. Ask things like, am I going to have sutures or am I going to have surgery? staples. Um, we, we, sutures are definitely more preferred, uh, because staples are not fun to get out afterwards.

But ask your doctor these things. Where do you expect to make these incisions? How many incisions are you expecting that you're going to have to make? What is the risk that I have to incision that's similar to a C section? What is, my individual risk for developing a blood clot. I went to a cardiologist, it's required when you're in your 40s, but really I think everybody should consult with a cardiologist if it, if it's accessible to know what their risk factor is for a clot, um, to get an EKG and make sure that like there's no heart arrhythmias, there's no issues there, like get it worked up and make sure that You're comfortable going into this.

So, [00:58:00] I want to give you permission to be annoying. There should be somebody at your doctor's office to answer your questions, and you should be able to ask as many questions as you like.

Make sure that you arrange for child care, someone to take care of household tasks. Like, this is something that I think we really need doulas or like, you know, midwives, like people to come in and help people post hysterectomy, post, um, endometrial excision, post really fibroid removal, like anything that's happening in your pelvis, like That can lay you down for a while.

Like I said, you want to get up and you want to move, but like you also need to rest. And so make sure that you have somebody that's going to come in and help you. If you can just like Uber Eats stuff, Uber Eats stuff. If you can meal prep ahead of time, have everything you're going to need. Make sure you do that.

All the laundry needs to be done, um, ahead of time. If there's toys and towels and things [00:59:00] on the floor, let them be. You've got a month, you let them be. If you go and push them around with a broom, I'm not judging you. Take care of yourself and make sure you have an opportunity to rest.

Now, a tool I think could be really helpful in this that I'm going to employ is journaling. Writing down your thoughts, your feelings, your emotions, getting those out before surgery. When I wake up from surgery I might do this too. And after surgery as well. But journaling is a really healthy easy way to process your emotions and it can always be helpful to go back and read how you were feeling in the past.

But maybe for you it's going to look like prayer. Maybe it's going to look like meditation, but whatever it is that helps you process your emotions, please make sure you hold space for that.

Okay, so I [01:00:00] just want to take a moment to summarize a timeline for you. So, four weeks before surgery, start optimizing sleep, start improving your nutrition, start your supplements.

Two to three weeks before surgery, make sure you're on the anti inflammatory diet. Okay, so four weeks you start optimizing things. By three to two weeks, counting down to the surgery, make sure you're on that anti inflammatory diet. And ensure you're being adequately hydrated. This will matter weeks in advance.

If you haven't started supplements yet, this is the time to definitely get the supplements on board and to begin those.

Two weeks before your surgery, make sure that you are finalizing the post op with your doctor, that you're getting [01:01:00] all of your questions answered. This is going to help mitigate anxiety and stress before you're going into it. And if you haven't started stress reduction practices, tending to your emotional health, start it now.

One week before surgery, this is where we start cutting out supplements that could lead to blood thinning issues, okay? We don't want anybody, let me back up. A week before surgery, this is where you look at the supplements you're going to come out. A week before, a week before surgery, you start looking at the supplements you're going to cut out to make sure that there's nothing that's going to interfere with medications or have any kind of blood thinning impact.

You may also want to start dialing back your exercise at this point. The day before surgery, you're going to do the bowel prep, if that's part of your protocol. And that might look like consuming clear liquids only.[01:02:00] 

So I hope this has been helpful for you to put together kind of a pre game plan of heading into excision surgery to enable your body to be able to heal at. So I hope that timeline is helpful and I hope this entire podcast episode has been helpful in you being able to put together a game plan heading into excision surgery.

You can certainly use this if you are looking at going into any kind of surgery and really tailor it to your needs. towards that. This isn't just endometriosis excision specific. There's lots of other surgeries that this would apply to. So as always, please like, share, subscribe, leave me a comment. You guide the conversations here and I always want to be delivering the most helpful information to you.

 

So let me know what that is and we will make sure that it comes out in a future episode. [01:03:00]