Dr. Devin Garza

Did you not have any pain to begin with? If not, well, I am in the exact same boat as you. I had extremely heavy periods (back in 2017 before I got my iud, I was losing 15+ ounces of blood per period. Normal is 2.7 ounces) and mild cramping that edged more toward "moderate" this past year. What triggered the endo surgery was occasional severe 9/10 pain that made me vomit after a bowel movement and lingered for hours. I had excision + a hysterectomy last Wednesday and the endo was on my rectum, with adhesions and inflammation on my bladder, tubes, and pelvic wall. Even during my recovery, the pain has been so manageable I'm astounded. I was off of pain meds 5 days out and the only pain now is if I press on an incision, and there's some heaviness/pressure when I pee. My big worry now is that if it comes back, I won't know until it's infiltrated my bowel or bladder or something else that can't just be cut out and discarded. I see my surgeon (excision specialist Devin Garza in Austin, TX) in 2 weeks, and I'll let you know what he says. Hugs. Edit: forgot to say that my endo was Stage II. Did your ob/gyn say what stage yours was?

Who is the surgeon? Do you have to pay up-front? Honestly, there is tons of info out there about getting medical bills reduced (like asking for an itemized bill and then contesting anything duplicated or priced too high, then asking if they will write off the rest if you pay X amount that day). I've also read that Catholic hospitals are more likely to have financial aid available or write off medical debt because the Catholic church has deeper coffers than most. And non-profit hospitals will generally be a better bet. Honestly, though, as scary as it sounds, you would do better to have the surgery first. If, post-surgery, you explain to them that you can barely work due to the pain you're in, a non-profit hospital would most likely work with you and let you make small payments. If the surgery is with the same surgeon, btw, it might be worth changing surgeons if he/she wasn't able to help last time. Where in Texas are you located? I had my surgery the other day with Dr. Devin Garza in Austin, and only $350 (the surgical assistant's fee) was due prior to the surgery. The rest of my copays--to the surgeon, the hospital, and the anesthesiologist--will all be billed later.

So this is something that my surgeon (Dr. Devin Garza) did address briefly, and if I remember correctly, he removed my adhesions and then washed the areas with platelet-rich plasma, which is supposed to reduce the chance of the organs fusing back together. Here's some info about it! https://centerforendo.com/adhesions-update#:~:text=Plasma%20is%20the%20blood%20product,excision%20of%20endometriosis%20and%20adhesions.

A mortifying story about endo on the bowel AND a suggestion for those of you who don't need birth control A mortifying story about endo on the bowel AND a suggestion for those of you who don't need birth control I'll try to keep this short. I was diagnosed with stage 2 via lap (by Dr. Garza in Austin) last July. I don't want kids and my husband had already had a vasectomy, so Garza agreed to do a hysterectomy at the same time as the lap. The lesions were on my rectovaginal septum, and other than menstrual/crampy symptoms, my main symptom was 9/10 pain, severe enough to cause vomiting, immediately after a bowel movement. It wasn't daily, at least--more like weekly. I stayed on Slynd post-surgery, but began to suspect that the endo was returning back in September/October, just a few months after the surgery. By February, I was positive it was back due to some pain I'll talk about below. That same month, I saw a new gynecologist who doesn't do obstetrics at all, and she took me off Slynd due to a med conflict and put me on 100 mg of nightly progesterone. She said it would have the same effect (hopefully) as the Slynd, slowing or preventing endo regrowth, but wouldn't cause issues with my other meds. Well, my pain got worse on only 100 mg. As March/April/May went on, I began to have horrible pain immediately before a bowel movement, and the pain only got better after going to the bathroom. By June it was happening daily and I could no longer predict l when I'd need to go to the bathroom, so I literally had to walk into Ross or Home Depot or the craft store and immediately locate the restroom in case I had to rush there, clutching my belly and trying not to cry. It led to some awkward knocking on the bathroom door at times. It was mortifying. So I followed up with the gynecologist in June and also followed up with Garza later that week. The gynecologist doubled my progesterone to 200mg, and Garza was dubious that the endo could have returned so quickly and severely. They both referred me to their colorectal surgeon to rule out other issues before we discussed next steps. But while I waited the 4 weeks it took to get the colorectal consult, the pain got way better on the 200 mg dose of progesterone, and that surgeon agreed that it is most likely endo. We are holding off on surgery for now, but it is almost certainly going to be necessary in thr next few years. So for anyone who doesn't need birth control meds due to relationship status or a hysterectomy or what have you, plain progesterone is an option and it's cheaper than Slynd. I was reluctant to go off hormones altogether because my mental health was f***ed when I was only on an IUD and not oral hormones. There is an increased risk of breast cancer and lower risk of ovarian cancer on progesterone, and I guess my thoughts in re: to that are that at least we have a fairly affordable tool, the mammogram, for detecting breast cancer, while ovarian cancer frequently isn't detected early enough.

Oh yeah, Garza is an excision specialist, so he did remove all the visible lesions. Sorry, I should have been more clear, but I was trying to keep it as short as I could. I wanted the hysterectomy because I didn't need my uterus and was sick of heavy periods and breakthrough bleeding. Oddly my periods weren't really all that painful, just moderate cramping, but I bled like a stuck pig. I actually ended up in the ER twice in November 2022 when I had an IUD removed and bled so heavily that I was wearing adult diapers for days and sleeping on a puppy pad because I got sick of waking up to stained sheets. They were talking about transfusions when we finally got it stopped.

I had a total plus salpingectomy two years ago.  So they took my tubes, uterus, and cervix (my surgeon said with endo patients, it's best to tak the cervix with the uterus because otherwise you might still have a mini-period).  Left my ovaries alone. I have had a recurrence, as unfortunately the ovaries produce estrogen and estrogen is one of the factors that drives endo.  However, 10/10 for not dealing with periods anymore.   My recovery was very easy, and I did go to a specialist (Dr. Garza in Austin).

Personally, if someone had accidentally nicked my intestine and landed me with a colostomy bag, I'd be going elsewhere for successive surgeries. What state/country are y'all located in? Any insurance? Maybe someone can hook you up with a specialist, depending on where you are. An endo specialist is going to be a gynecological surgeon who no longer deals with more run-of-the-mill women's healthcare like PAP smears, delivering babies, treating yeast infections, etc.--they only deal with endo and maybe similar conditions like adenomyosis. As a result, they are going to have far, far more knowledge about the issues your sis is facing than an ob/gyn just because of the sheer amount of time they will have spent in surgery. I went to Dr. Devin Garza in Austin, TX for my first lap (probably will have another this year or next) and if I remember correctly, he used platelet-rich plasma at the end of my surgery to reduce the occurrence of adhesions. Here is a study that talks about using PRP in other gynecological surgeries: [https://www.jmig.org/article/S1553-4650(24)01460-2/fulltext](https://www.jmig.org/article/S1553-4650(24)01460-2/fulltext) I can't guarantee that seeing a specialist will turn out 100% perfect for your sis, but hopefully she at least won't wake up with a colostomy bag. Oy.

Ask about the on-q pain pump.  It is a pump attached to a sort of porous tubing that dispenses a topical anesthetic (ropivacaine is what was in mine) for the first few days post-surgery.  The pump is attached to you and you carry it around in a fanny pack-type pouch.  Then you remove the tubing yourself (and yeah, that part is super strange feeling) when it's empty.   Dr. Garza used that with my surgery (laparoscopic total hysterectomy, salpingectomy, and excision of endo from my rectovaginal septum) and I had a very easy recovery.  He prescribed Tylenol 3 (which is Tylenol + codeine) and told me to alternate that with ibuprofen.  I took the tylenol 3 as prescribed for 3.5 days before gradually spacing the doses out and ceasing it on day 6. I waited until after the on-q tubing came out on day 3 just to make sure my pain levels didn't skyrocket as soon as it came out.  Then continued with just ibruprofen before spacing that out and stopping it maybe 10 days later.  Garza said I probably have high pain tolerance, though, because I didn't develop severe endo pain until earlier that year (main symptom was 25 years of very, very heavy periods) but I have been in moderate daily pain for years due to fibromyalgia.   My main advice for after your surgery is to listen to your body.  Yes, walk as much as you can to help dissipate the gas, but otherwise, if it hurts, slow the heck down.

Same. I had lots of adhesions on my pelvic wall and one lesion on my rectovaginal septum. Garza in Austin said it was stage 2. But the pain was severe enough to make me vomit fairly regularly.  and evidently I have a high pain tolerance from years of fibromyalgia because Garza has seen it all and he was surprised at how quickly I was able to.stop painkillers.

Trigger warning for rape and medical trauma OP, Find a different doctor. Those meds will help some, but I don't know how much. Three years ago, I had an IUD removed and started bleeding heavily later that day, to the point that I was wearing adult diapers and sleeping on puppy pads because otherwise I kept waking up covered in blood. The whole thing was mortifying, and I ended up in the ER twice getting my hemoglobin levels checked. In the middle of all that, my ob/gyn (who I'd just met when she removed the IUD) did an endometrial biopsy. She had taken my history just a few days before, so she knew I had been raped, that I had PTSD from said rape, and that I had prescriptions for celebrex (a prescription NSAID) and klonopin (for anxiety). She knew I was married and could have at least asked if I wanted to have a driver. Instead, she did not tell me I was having a biopsy that day and let me show up as if it was a normal appointment, and didn't even tell me to take some fucking ibuprofen. I found out the biopsy was happening about 60 seconds before she did it, and she also decided to throw in a colposcopy without getting my consent. I had a flashback mid-procedure with the instruments inside my uterus and pretty much had an out-of-body experience. I just remember screaming and arching my back and her scolding me to hold still. I ended up crying so hard I vomited in the bathroom and had to sit in my car for an hour until I was calm enough to drive myself home. I didn't even find out I'd had a colposcopy from them; I found out 5 months later from Dr. Garza, the endo specialist I had my records sent to, when he mentioned offhand that I'd had a colposcopy and so my prior doctor must have had reason to think I was at risk for cervical cancer. I've had a difficult time trusting doctors since then.

As far as jumping through hoops, well, the treatments you have already been through are pretty extensive and many are quite expensive (like Myfembree) meaning that your insurance has already spent many thousands covering your care. Do you have a surgeon willing to do it?   The biggest hurdle is going to be your age, and the fact that I'm assuming you don't have any kids (since you don't mention any).  Lots of surgeons will refuse it because a hysterectomy can't be undone, obviously, and they don't want to be responsible if a young person says they don't want kids and then changes their minds later.  "I am in horrific pain and couldn't even begin to contemplate carrying a baby" and her sister argument, "I would make a terrible parent because I am too busy puking from the pain to effectively care for a child" both worked in my favor. I had my hysterectomy in 2023 with Humana.  Part of the impetus for my diagnosis was that I had an IUD (Liletta) and started to have more issues with it. Pretty sure my endo was growing at the time because one of the issues was really strange--I used a menstrual cup successfully for more than a decade and then began to have issues with it leaking.  I couldn't get it to form a seal, and I tried changing brands and sizes.  It was like I'd changed shape internally, and during my lap the next year, endo was found on my rectovaginal septum, so that explained it. Anyways, when I wanted to try going hormone-free, they removed the IUD and I began bleeding like you mention you did.  It led to two ER visits, a round of estrogen therapy, a horrifying endometrial biopsy with no warning and no meds, etc.  Finally tranexamic acid stopped it. I began to have terrible pain two months later. When I had my hysterectomy, I went to Dr. Devin Garza in Austin, and I told him I wanted a hysterectomy and asked if he could also look for endo while he was in there. As far as I know, they didn't have any issues getting the surgery covered.  I did have the IUD, as I mentioned, for 5 years, but there was no word from my insurance that I needed to try a new one before resorting to surgery.  I never tried Myfembree or Orilissa (osteoporosis runs in my family, so I really want to avoid those; if it runs in your family as well, that might be worth mentioning as a strike against them).  My former ob/gyn, the one who did the endometrial biopsy and threw in a nonconsensual colposcopy for funsies, did try to send in a prescription for Orilissa a few months before Garza did the hysterectomy.  She did it after I reached out to ask about what to do when I puked from pain shortly after taking my birth control, but Humana denied coverage for it.  I wanna say the denial said something about the drug being too risky to take without knowing for sure that I had endo.  I never wanted to take it, so didn't care one way or the other.   You might also want to look up the types of hysterectomies just so you can talk confidently about it with your surgeon and insurance.  I can see why you'd want a radical hysterectomy in your shoes, but that might be a step too far in some surgeons' eyes, so prepare your arguments now.  And in the meantime, document. The more crap there is in your file about how miserable you are, the more you'll build your case that a hysterectomy isn't just in your best interest, but will also save your insurance company money in the long run.   the more likely they might be to approve it.  Pain particularly bad and you miss work?  Portal message to ask them if XYZ  Pain

Mine has returned, but we have the pain somewhat controlled for now.  Surgery was in early July 2023.  I had 9/10 pain after a bowel movement, severe enough to cause vomiting. Lesions were on my rectovaginal septum, lots of adhesions everywhere. Stage 2. By Sept/October 2023, I began to suspect the endo was returning.  In the years prior to the surgery, I had begun to have more and more GI issues.  It was like my digestion was super slow even when I got plenty of fiber and water.  After the surgery, it felt normal again.  And then began to revert back to being slow/weird as of that fall.   I was on Slynd at the time of surgery and stayed on it until the following January.  At that point, a new (new to me, I mean) gyn told me that she wasn't comfortable with me being on Slynd because it was contraindicated with another med I was on, and so she moved me to plain progesterone, 100 mg.  By April 2024, the pain was horrific again, only this time it came on before a bowel movement, not after, and didn't subside until after I went to the bathroom.  It was completely mortifying and I pretty much became a total shut-in, dropped out of the 2 choirs I sing in, etc. I was afraid to drive anywhere if I hadn't gone to the bathroom yet that day because I'm in a rural suburb and it's a 20-30 min drive even just to get to a good grocery store.  If the pain had come on while I was on the highway, I would have had a wreck or, to be blunt, sh*t myself.  The pain was worse if I consumed a lot of fiber, too.  It was mortifying; I literally couldn't be in a public place without immediate access to a restroom.  I'd have to walk into Lowe's or Michael's and immediately locate the restroom in case I had to waddle there, trying not to cry.   It was a 6 week wait to get back in with my gyn, and when I saw her, she pooh-poohed my insistence that the endo was back and said it sounded like a food intolerance.  But she was also upset that I planned to go back to my specialist (Devin Garza in Austin) and not to her for future surgeries. But she wouldn't have been an option anyways because she's retiring this month. Anyways, she did increase the progesterone to 200 mg and referred me to get established with the colorectal specialist that she did co-surgeries with.  It was a 5-week wait to get in with him...and by that point, I was positive it was the endo because the pain was markedly better.  Still bad, but more like 5/10 instead of 8/10.  We eventually went up to 300 mg of progesterone per night, but we backed off a bit on the dose to see if it was causing bladder issues.

Can you bear to wait and have the specialist do the whole thing?  Honestly, it'd be easier and cheaper to wait, bc then you'd only have to do one surgery.  I went to Dr. Garza in Austin for mine.  Described my symptoms and said I wanted a total hysterectomy (so leaving behind only my ovaries, and removing the uterus, tubes, and cervix) and asked if he could look for endo while he was in there.  And he did.   Whereabouts are you located (a very general location)?  If you update it in your post, maybe we can help you get together a list of specialist names.

So...this post could have been written by me 3 years ago.  I am 37 now. Was diagnosed with fibro when I was about 26 and got on SSDI for that + PTSD when I was 29. Had heavy periods all my life, but with minimal cramping for the first 20+ years. Evidently my old ob/gyn suspected endo when I was 29 because she pushed for an IUD, which I got, and also pushed for me to keep it when it made me spot constantly for the first 10 months.  Would have been nice if she had said so, so I knew what symptoms to look out for.  In summer when I was 35, it was super weird because I had used menstrual cups for well over a decade and all of a sudden they wouldn't form a seal.  I wasted money on different brands and sizes of cups, on menstrual discs, etc., and everything leaked.  The next year I got my answer because I began to have excruciating pain (severe enough to cause vomiting) when the endo reached my rectovaginal septum.  I had to seek a diagnosis.  I had excision surgery with a specialist and the pain and bowel issues were immediately better.  And I wasn't interested in kids, so he also did a total hysterectomy (removal of uterus and cervix) and salpingectomy (removal of fallopian tubes).   The issue we have had has been how to prevent endo regrowth.  We seem to have figured out the right dosage of progesterone, but before that was sorted out, the endo did regrow.  The progesterone is managing the pain right now, and I'm due for one more surgery next summer to get rid of whatever regrew before they increased the progesterone dosage. I'll stay on that dose (200 mg) post-surgery, and I'm hopeful that that will handle it. I understand your concerns about scar tissue, but if there is a specialist near you who knows their shit, they can take measures to minimize adhesions.  Dr. Devin Garza, the specialist I went to, utilizes platelet-rich plasma therapy during surgery to minimize adhesions.  From my understanding, they draw the patient's own blood, spin it in a centrifuge to separate the components, and then apply the plasma anywhere inside you that they make a cut.  It's supposed to promote healing and healthy tissue regeneration.   Have you talked with the surgeon yet?  I definitely understand your concerns about cost.  :( All I would say there is that most hospitals have a charity program where they will reduce or forgive your bills if you're low-income.  If you ask the billing office after the surgery, they can send you a form to fill out.   What about the fibro diagnosis doesn't fit, out of curiosity?  And whereabouts do you live, generally? Maybe if the surgeon you were considering doesn't use PRP, we can hook you up with another one who does.

In Austin, TX.  I'd say 4 for my overall experience, but 8 once I began to seriously show symptoms.  I always had horribly heavy periods, since I was a kid, but pain was minimal.  They would always just throw birth control pills my way, and eventuallly my old GP set me up with an IUD.  Then I spotted for like 10 months with the IUD before that finally resolved. In summer 2022, I began to have what I'd call minor symptoms.  Some discomfort during sex (not quite pain), my periods got heavier, I began to have constipation even with plenty of fiber, and my menstrual cup would no longer form a seal no matter what I did, even trying different brands. In November of that year, I had the IUD removed and had a long episode of heavy bleeding that was difficult to resolve.  Then the following January, I began to have severe pain after a bowel movement, severe enough to cause vomiting.  From there, we got to my diagnosis rapidly, as soon as my ob/gyn mentioned endo as a possibility.   I googled endo specialists and found Dr. Garza.  Scheduled with him for March, and in the meantime, they wanted to rule out colon cancer (family history) and so I had a colonoscopy in February.  That came up clear, and when I spoke with Garza, I asked if he could do a hysterectomy and while he was in there, look for endo.  And so that's what we did that July.  Stage 2.  So it was 6 months from the onset of the really bad symptoms.

I am glad you told them.  I also wanted to mention that if you could talk to your surgeon, maybe they could do an on-q pain pump after the surgery?  Garza did mine, and he used a pain pump with ropivacaine, and it really reduced the pain without necessitating heavy opioids.  It only lasted 3 days, but made it so I could get back on my feet pretty well the first few days and "walk off" the gas they use during the lap.

Thank you for your insight. Dr. Devon Garza in Austin Tx did my surgery and he is the best and one of the pioneers of the excision surgery I had. I also had endo on my bowel and bladder and it was wrapped around my appendix. My appendix was removed as well. He said he think he removed almost 100% of it. He is empathetic and fantastic so if you need an excision surgery with how bad mine was, I would say go to him. He left all of my female anatomy intact and I was a mess with cysts and endomatriomas everywhere.

Oh my goodness. Best of luck to you! I hope you find the right excision specialist. 🙏🙏💕💕 I had a colorectal surgeon there to remove the appendix. I also had a benign mass in my peritoneum, which is why I had both surgeons. The mass was the size of a grape fruit) His name is Thiru Lakshman. They work together ALOT. So they both did the surgery at once and dr. Lakshman removed the appendix as well. Dr. Garza removed all of the endometriosis in other places. Best of luck to you! I hope you get the excision surgery you need! ☺️

Thank you for the info and all of the references above. I had excision surgery for my endo. It was on my bladder, bowel, and my ovaries we’re attached to my uterus. He removed all of it. My surgeon was DR. Devin Garza and he is also one of the pioneers of the endo excision surgery. My appendix was removed because the endo was wrapped around it. I also had a benign mass the size of a grapefruit in my peritoneum that was also removed. But…there seems to be no answers for management and treatment outside of surgery, birth control, or a hysterectomy if the symptoms come back. I truly feel endo is an auto/immune condition and manifests in the fallopian tubes and ovaries, but there is so much more to it than that. We have years before we get there though and it’s just a shame most of us have to suffer in the interim.

Dr. Devon Garza is an excision endo surgeon and stays up to date on information he even has lectures online/you tube. He is very compassionate and listens. Fantastic bedside manner. He removed my endo last January. I have stage iv. It was on my bowel, peritoneum, bladder and my appendix was removed by a colorectal surgeon at the same time. I also had a benign mass in my peritoneum that had to be removed by the colorectal surgeon as well. But he excised all of the actual endo. Hope this helps.

If you have a PPO plan you may be able To just set an appt for a surgery consult. He typically does an MRI first. I did go to my regular gyno and the MRI got me a referral to an oncog-OB because they were not sure about the mass that was in my peritoneum. Then she referred me to Dr. Garza.

Oh that's amazing!! I almost went to him but the drive was crazy far..I went to Garza in Austin instead. Can I ask what's your post surgical plan? I desperately need pelvic floor physio. But also I can't get my pH back to normal! If you have any recommendations I'm all ears haha I'd love to hear what he did

I wish I had more details about the tubes. Getting rid of pain was my only concern so I didn't ask anything about that part. I wish I could give you more details on it! Hmm Dr 2.... Is it excision or ablation? The fact that he didn't say excision is a red flag but he may do it. If you have any on your intestines or bladder though I'd still rather be with a specialist, especially if she did her fellowship in it. My surgeon was Garza in Austin. Definitely life changing but I had a lot of complications. And make sure you ask them to explain EVERYTHING they're going to do to your body for the surgery. Catheter, prep, disinfecting, EVERYTHING. I didn't. I wish I had so I could have educated myself for care after.

I am sorry you are dealing with these symptoms, good job on taking your health into your own hands. I recommend joining the [Endo Forward Foundation](https://www.endoforwardfoundation.com/), it’s a local non-profit organization that supports women going through the same journey as you. They have been incredibly helpful. Finding a specialist is a great place to start! I would check to see if your insurance covers pelvic floor therapy too. You should be able to ask your gynecologist for a referral via mychart. [Origin](https://www.theoriginway.com/texas/south-austin) is great place to start, I know Texas urology does pelvic floor therapy as well. I have seen them both but prefer Origin, they were incredibly helpful with reducing my UTI symptoms. Not all pelvic floor therapy is the same. Educating yourself on this disease will be incredibly helpful. I wish I would have known before hand that endometriosis does not have a medical board supported speciality. Most of the medical community doesn’t know the proper definition of the disease. Surgeons are not all educated and trained the same. I only consulted Dr Garza before my first surgery, I wish I would have gotten a second opinion. I have now consulted 5 different specialist in Texas. Dr Garza is a compassionate listener compared to most gynecological specialists in the area. To be honest, the bar is not set high when it comes women’s health in Austin. I would trust him with a hysterectomy but not a complex endometriosis excision. He is the only Dr connected with Nancy Nook, so he is the most advertised surgeon in the area. Personally, my post-op experience was less than stellar. He did my first surgery in 2023 and my pain increased as I continued to “heal”, a year later I found out he spread the disease on my bowels and uterus because he continues to use dated techniques. There were obvious signs of ablation as well, he didn’t have the training to excise Endo in certain areas. He missed several large lesions on my ureter and right rib cage. He has not completed a surgical fellowship (a Fellow of the American College of Obstetrics and Gynecology is not the same as a surgical fellowship). He is also an employee of Intuitive, the company that makes the DaVinci robot. He was paid [$299,296.56](https://openpaymentsdata.cms.gov/physician/35908) in 2023, as surgical trainer. Intuitive has never donated a cent to endometriosis research. Dr Garza is not the only option in Austin, [Dr Jenny Travieso](https://uthealthaustin.org/directory/jenny-travieso) and [Dr Christina Salazar](https://healthcare.ascension.org/find-care/provider/1083902068/christina-salazar) have clinics with ascension health and Dell medical school. They have both completed a MIGS fellowship (minimally invasive gynecological surgery). I consulted Dr. Travieso after my horrible post-op experience with Dr Garza. She had completed her MIGS at the University of Michigan, which focused primarily on [endometriosis excision](https://aagl.org/wp-content/uploads/2023/01/University-of-Michigan-Program-Description.pdf). I was impressed with her bedside manner and knowledge of the disease. Ultimately, I decided to go with a surgeon in Dallas who had more training and published research with bowel excision. Dr. Salazar’s MIGS program from Brigham University also included [endometriosis training](https://aagl.org/wp-content/uploads/2024/02/Newton-Wellesley-Hospital-Program-Description.pdf). I couldn’t find any bowel Endo specific research from their program, which was important to my case. I know I rambled, I just wanted to share what I learned the past year in the hopes it will help you and anyone else looking through Reddit posts. I know Dr. Garza has helped many women in the past, I suspect his practice has changed recently. I have connected with several woman who had surgery in 2023 with Dr Garza, excision only, we have all needed another surgery within a year.

It’s hard to compare experiences since this disease is incredibly variable and hasn’t been categorized correctly by the medical community. My comment is for you and for anyone looking for experiences with him. Dr Garza is not your only option. There are several surgeons in Austin that have completed a fellowship in robotic surgery for female conditions. Dr. Garza is the only one connected with the nook, which is not a medical board accredited list of “endometriosis surgeons”. Nancy’s Nook is not transparent about how surgeons are selected and added to the list. Christina Salazar, MD, FACOG & a few others that I need to look up when I am not on my phone. Dr. Garza, while experienced, has not completed a surgical fellowship, specifically a MIGS (minimally invasive gynecology surgery). This type of fellowship is not specific endometriosis but it can include valuable training for the disease which is necessary for successful surgeries. As far as I know, Dr. Garza is also a surgical trainer for Intuitive, the maker of da Vinci robot that assists most surgeons in endometriosis excisions and 1,000s of other types of surgeries. He has trained other gynecologist is the area, like Dr. Neyman, who has very similar reviews as Garza. He is not offering a ABOG recognized surgical fellowship. I only experienced partial relief from my excision surgery from Dr. Garza, while gaining many other new symptoms that greatly impacted my life. I also experienced patient abandonment after continually following up till 6 months post-op, I did not get a partial or full hysterectomy. Most of the women who I have spoken to usually have some sort of relief were only hoping to conceive or received a hysterectomy. I consulted several endometriosis excision specialists in Texas after my symptoms worsened. After my second surgery with a different surgeon, I was told that endometriosis was left on my bowels, left ureter, left kidney, and under my left rib cage and liver. Additionally, there were signs of ablation and the use of “hot scissors” on my rectum and pelvic floor. The use of hot scissors spread the disease on my PF and bowels, there was obvious signs of “splattering”. The Endo on my rectum was not fully removed and pathology showed signs of growth.

Sorry, just saw this. He’s a great listener and validating my feelings and symptoms, I will give him that. His surgical skills and ability to remove and find Endo were not as advertised. I woke up in pain and it never stopped till I scheduled a second surgery with a different specialist in Dallas. His NP suggested that I go on antagonist medication. I turned down that option. When I saw Dr. Garza 5mon post-op he said my Endo was so minimum and he was certain he removed it all, there was no way causing all my current pain and to explore other gastro conditions and accept it was scar tissue. It was such a disappointing appointment, he was so dismissive. I also want to say, I made it certain that I wasn’t seeking pain meds, I just wanted answers or a recommended path for answers. I wanted that documented on my chart. His response to this was rude and condescending. I saw his colorectal surgeon again, got a second opinion from another. Every test showed nothing. A little over a year after my 1st surgery, I had a second one. I found out that he left many lesions, I think 13? They were on my pelvic floor, urethra, bladder, kidney, rib cage and on the tendons around my liver. There was also a large endo mass on my urethra. On top of that, there was signs he ablated lesions on my ovaries, uterus, and rectum. I requested my surgical notes from Dr Garza and they confirmed he excised and ablated lesions. This was never mentioned to me. My second surgeon said not a single lesion was fully removed from the first surgery. With the ablation he spread the disease all over my bowels and pelvic floor. The is called “splattering”. Dr Garza said the lesions he removed were only “superficial” while most of them were DIE. I had very little scar tissue found during my second surgery. If you compare my operation pictures of my abdomen and pelvic floor, especially around my rectum, the looked healthy. During the second surgery, there was a lot of discoloration and inflammation. I lived in compression stocking for almost a year. I could barely walk. It felt like there was very little circulation to my legs. I know there is a risk for nerve damage with every surgery, but after I woke from my second one I knew things have improved. Significantly. I haven’t even thought about compression stockings. I still have significant nerve damage on my rectum from my first surgery. That may never improve. I am on HRT and doing pretty well!

You can see my above comment for the MRI results today. Super interesting and also correlated to pain I have on that side, I’ll be interested to see what it turns out to be! The nurse also said that lots of times patients imaging comes back totally clear but then in surgery Dr Garza says it “looks like an endo bomb went off in there.” So that was good to hear, I guess. Hoping your surgery goes well as well!

I had surgery with Garza in April of this year, and while I did not have the level of horror you had, I consider my experience to have been negative. Initially I was really surprised and encouraged by how seriously he took my reported dyspareunia, which I always considered just a secondary symptom and don’t think much of it but he was really validating about wanting to “fix” that for me. Looking back, I think it’s kind of weird how much he focused on that. I have 3 kids and so his initial rec was hysterectomy which I was not up for, even though we don’t want more babies, that just felt really final. So we proceeded with excision and he did not find much endo. He said Stage 1 mostly but I had a lot of pelvic adhesive disease which indicated to him that I probably had a lot more microscopic implants in there which was caused all the post inflammatory changes and adhesions, so he classified as Stage 2. My recovery was a LOT harder than I expected. I’ve had 3 unmedicated vaginal births and this recovery was harder. Follow up was so rushed and limited. I had freaking awful dysfunction uterine bleeding, 4x17 day cycles. Just bizarre irregular awfulness and no one could explain to me why or when it would regulate, other than “sometimes cycles are weird after surgery” Seven months out I feel basically no different than pre-op. Still take 800mg ibuprofen around the clock for first 2 days of my period. Still have painful sex. Hindsight I wouldn’t do it again.

Surgeon shopping! Surgeon shopping! Have you had a particularly good experience with an excision surgeon? If so, I would love to hear about it! I'm willing to travel anywhere in the US! Would love to hear your positive experiences, especially with endometrioma, reoccuance, and bowel endo. Thanks! A bit about me: I had excision w/ Dr. Devin Garza in 2018 and he found stage I w/ a ruptured endometrioma. The recovery was very difficult and took over a year and I didn't love how he handled after (very hands off). For the last year I have had extreme IBS, good intolerance and lower left pain and found a new endometrioma on the left ovary. I suspect bowl involvement. Would love to hear your positive experiences. TIA!

So glad you found something that helped for you! I also had excision with Dr. Garza in 2018 for stage 4 endo with endometrioma. I refused bc after surgery, knowing that it does not slow or prevent endo growth. Though I low key wish I had done continuous bc for thr first three months after surgery just to skip that awful post surgical period pain My GP put me on bio-identical Progesterone last fall saying it would help balance my high estrogen levels, but it messed me up. It caused a deep depression I had never experienced before that only time and therapy helped. I also had sever pain with bowel movements this year and my gastro Dr had me do a CT scan which found a large ovarian cyst on the left side, right where I experienced the pain with bowel movement. So once I knew what was going on I started taking NAC supplement which has been shown to decrease cyst size and have been feeling better after three months of taking them. I have a follow up with a vaginal ultrasound to check that it's not getting bigger. If it gets bigger I'll talk to either Garza or Guan in Houston about having another surgery but keeping my fingers crossed that the supplement is helping enough to shrink the cyst! Anyway, thought you might like another perspective. Everyone's body is different and I'm so happy you have followed your instincts to find what works for you!

So glad you found something that helped for you! I also had excision with Dr. Garza in 2018 for stage 4 endo with endometrioma. I refused bc after surgery, knowing that it does not slow or prevent endo growth. Though I low key wish I had done continuous bc for thr first three months after surgery just to skip that awful post surgical period pain My GP put me on bio-identical Progesterone last fall saying it would help balance my high estrogen levels, but it messed me up. It caused a deep depression I had never experienced before that only time and therapy helped. I also had sever pain with bowel movements this year and my gastro Dr had me do a CT scan which found a large ovarian cyst on the left side, right where I experienced the pain with bowel movement. So once I knew what was going on I started taking NAC supplement which has been shown to decrease cyst size and have been feeling better after three months of taking them. I have a follow up with a vaginal ultrasound to check that it's not getting bigger. If it gets bigger I'll talk to either Garza or Guan in Houston about having another surgery but keeping my fingers crossed that the supplement is helping enough to shrink the cyst! Anyway, thought you might like another perspective. Everyone's body is different and I'm so happy you have followed your instincts to find what works for you!

Dr. Rachel Haverland - female, not as experienced though Dr. Anthony O'Connell - Dallas I would not recommend Dr. Dulemba, Dr. Garza, or Dr. Guan, but that is just from personal experiences. Either long wait times, disorganized offices, or a failed excision. Loads of other people have had good experiences. I'm just an outlier.

I found this updated [Map](https://www.theyellowhub.org/map?fbclid=IwAR1HBnhwqQ9Ju26vpztnkAE9Gn-yGRWMIo4mliVLgXhY5rDsCqRKN9Zsyjw_aem_AUPbzGllYGHE-zfeQxvmxsiFdteUhJOHnHgndOqEMoU_fctF91q5dp8tJ5_B-1d6h1c&mibextid=Zxz2cZ) last week! I have heard people say good things about Dr. Gregory Eads, MD in Houston and Dr. Stina Salazar in Austin. I have personal experience with Dr. Devin Garza, his clinic tends to be booked out though.

Two part review. Appointments & surgery I am still in the recovery phase even at 10 ish weeks out, I had several procedures done (endometriosis excision, myomectomy, hysteroscopy) Appointments You will schedule an appointment with his NP, Amanda and Dr. Garza after calling his clinic. They will be spaced out, mine was about 3 months in between. They are busy, but very nice. It’s a small clinic, with only Dr. Garza, Amanda, and staff- no other specialist. All of my virtual appointments have started late, I wish this was communicated with me when scheduling, I learned not to schedule anything important with in an hour of the appointment. First appointment went great, Amanda answered all my questions and ordered an ultrasound but no blood work (I have struggled with PCOS and requested it). She offered me birth control, I felt no pressure to take it) and recommended that I see Dr. Garza. Virtual follow-up with Amanda about ultrasound, fibroids had doubled in size and no visible sign endometriosis. I was very alarmed but she wasn’t. Appointment felt rushed. Virtual appointment with Dr. Garza, started about 45min late. He immediately said I had endometriosis, explained the disease to me and answered all my questions I had, referred me to a colorectal surgeon, and recommended surgery. I requested further imaging, but he said that wasn’t necessary. I was able to schedule a bit earlier than other people, due to a cancellation. It was about a two month wait after the appointment. Surgery I opted to not have a colorectal surgeon on stand by so my procedure was at St. David’s Surgical Hosptial, it’s a nice looking facility, they only use Austin Anesthesiology Group (awful reviews for bad billing practices, I didn’t have any issues). The hosptial staff were great, post-op was understaffed. Everyone I met said they love working with Dr. Garza and that he is a great doc. Pros, Dr. Garza and staff know what endometriosis is and they will validate your symptoms. He is the most trained gynecological robotic surgeon in Austin that isn’t catching babies. Amanda & Dr. Garza know the benefits of pelvic floor therapy and will give you a referral for it. It’s really hard to find a doc that will do that. I like the flexibility of the virtual appointments. I was not forced to take any hormonal treatments before or after surgery. I was given adequate amount of pain meds for my at home recovery, I also picked up all my meds two days before surgery. Cons, he’s busy that’s why they brought Amanda in, it’s just another step in the process. Appointments start late. Sometimes Amanda is bit late to responding messages.They are a small clinic, there isn’t an army of staff to help out or cover for things when Dr. Garza or Amanda is out. I experienced a little bit of disconnected between him and Amanda, but he was able to figure everything out during my virtual appt. I wish Dr. Garza would of been a bit more detailed or informative about the difficulties of recovery, with additional procedures. I tried to ask as much as I knew about it beforehand but it’s ultimately up the doctor. My biggest issue - I felt like he cut me and left me. I haven’t spoken to him since. Amanda does all the post-ops. He told my partner it was an easy surgery. I lost very little blood, they removed endometriosis but mainly talked about surprise fibroids. I thought easy surgery meant easier recovery, especially laparoscopic.