In this episode, we feature Dr. Jessica Drummond, as a part of our New Models series. You’ll learn what a big deal endometriosis is, and to what degree it acts like many other chronic illnesses that you’re probably treating in your practices. Dr. Drummond shares her new model that includes health coaching, technology, functional nutrition and physical connection to care for patients with endometriosis. Even if women’s health isn’t your specialty, there’s a ton of information in this episode for any practitioner looking to either streamline, grow their practice, or to take their innovation to more people.

Highlights include:

  • What reinvention of endometriosis care looks like for Dr. Drummond
  • How her team pivoted to virtual education when a hands-on approach wasn’t permitted
  • And so much more!

Resources mentioned in this episode:

New Models #7: Virtual Endometriosis Care ep259


James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.

Hello and welcome to the podcast. This week, we feature Dr. Jessica Drummond, and this is part of our New Models series. This episode is on endometriosis. In this episode, you’re going to learn what a big deal endometriosis is. You’re going to learn to what degree it acts like many other chronic illnesses that you’re probably treating in your practices and how Jessica’s new model that includes health coaching, technology, includes functional nutrition and physical connection, is really working to build a new model for endometriosis. And I think there’s a ton for any practitioner looking to either streamline, grow their practice, or to take their innovation to more people. It was a really interesting episode. Enjoy.

So, a warm welcome to the podcast, Jessica Drummond. Welcome, Jessica.

Jessica Drummond: Thanks so much for having me, James. It’s my pleasure to be here.

James Maskell: So we’re in the middle of a series this year on new models. I’ve just been following your work for the last few years and particularly around endometriosis, and I want to get into some of the ways in which you’re reinventing the care for endometriosis. But let’s just start at the beginning. I’d love to just get an overview of how you ended up in a space to be able to innovate in this way and what brought you here.

Jessica Drummond: Yeah. So, I’ve been working with patients and clients with endometriosis for the vast majority of my clinical career, about the last 20 years. I started as a public health physical therapist and worked clinically on teams with physicians who do endometriosis excision surgery. When I transformed a lot of my work to add a perspective of functional nutrition and health coaching, lifestyle medicine, one of the earliest things I did was teach my physical therapy colleagues how to integrate that with pelvic pain care because a lot of that is lifestyle medicine, all kinds of strategies for lowering inflammation.

Then for the last 12 years or so, in more of a telehealth model, I have been doing health coaching and functional nutrition with women with endometriosis and chronic pelvic pain conditions. Then I published a book in early 2020 called Outsmart Endometriosis, where I essentially documented and refined and systematized my perspective on working with people with endometriosis and chronic pelvic pain conditions. So that allowed me to leverage the, whatever, 18 years of experience before that and reach people to still work in multidisciplinary teams, because that’s very important in this chronic illness, but to be able to build a broader health coaching platform and essentially digital clinic that launched beyond myself, with a number of practitioners, in March of 2020.

James Maskell: Interesting timing to launch a digital clinic. That’s very interesting. We’ll get back to that. I mean, how big of a deal is endometriosis? How many people are we talking about have it? What are some of the root causes of it? And what are some of the ways in which the synergy of physical modalities and more of a functional nutrition approach and why does that synergy work so well?

Jessica Drummond: It works very well because this is a very common condition: 176 million women or people with uteruses globally struggle with endometriosis. It’s a well-known condition but not well-researched, and the therapeutic options for endometriosis for the first 10, 15 years of my career were not very good at all. It was pain medicine, pain management, hormone suppression and some surgical techniques that were not very good in terms of long-term outcomes.

But now, in the last 15 years, the therapeutic options are evolving. So, the physical therapy techniques to improve pelvic pain are improving significantly. The surgeries have improved. Now, people more commonly get endometriosis excision surgery done by skilled clinicians. And we now have a little bit better understanding of the underlying root cause, that it’s a genetic condition with an inflammatory and autoimmune overlay.

So, the functional nutrition work combined with lifestyle medicine really helps for long-term suppression of inflammation and improvement of barrier function to reduce the autoimmune component. As I said, it’s a very common situation, but not even very well-recognized by traditional gynecologists. It usually takes an average of 12 years to get a diagnosis. So, I felt like we were really filling a gap of bringing this integrative and interdisciplinary perspective to the world of endometriosis.

James Maskell: Yeah, that’s super interesting. Certainly, the number of conditions that have that genetic plus inflammatory plus autoimmune triumvirate, I guess, are many. Obviously, it affects different people differently, but certainly if you look at the root causes of so many of these kind of issues, you can see that if you take away the whole-body inflammation and you increase the integrity of the barrier, health can reappear in places where it had been lacking. So that’s super interesting.

So tell us a little bit about the book and what were some of the refinements or the protocol that you learned, and what did you learn from having other people implement it? Because I know some of this is a science and some of it is an art, and you learn a lot from doing it every day. And then sometimes when you’re trying to create that inter-repeatable framework, you could learn a lot through that journey when you’re working with other clinicians too. Right?

Jessica Drummond: For sure. So, when we launched the digital clinic more broadly, we had about six health coaches who I had been training over the years, and some of them were on faculty of our Integrative Women’s Health Institute, which is the teaching arm of the work that I do. So many of them have their own clinical backgrounds in either urology nursing or pelvic health physical therapy, and we brought on a naturopathic physician to help with the more clinical recommendations. It was a personalized, one-on-one health coaching program that took the model. But you’re right. I mean, applying the model individually requires also just everyone bringing their own perspective to the journey as well…the patients as well.

So, we did clinical rounds roughly every week, every other week, and really discussed the cases. That helped us recognize some common challenges that were coming up. Originally when I wrote the book, I had a fairly clean “therapeutic” elimination diet as a part of the protocol, but we began to realize that for some people that could be too restrictive. We had to do strong screening for eating disorder. Sometimes it was difficult to implement in its purest form and then have people start re-introducing foods without being too nervous to do so.

We learned a lot from seeing so many patients at once through a number of different lenses. I think that helped me to refine the food plan and actually make it just a bit more flexible or more therapeutic in that it’s more short-term for most people with some long-term changes that can be more personalized. And we learned that the activation of a parasympathetic nervous system through any number of strategies from mindfulness to cold plunges to breath work was really some of the more underutilized strategies that turned out to be even more important than the nutrition optimization.

James Maskell: Yeah, I can see how that’s a big piece. Tell us a little bit about how you took a physical modality and added it in virtually. Because I know when the pandemic hit, you have chiropractors, physical therapists, massage therapists, all kinds of practitioners realizing, “Hang on. I obviously can’t work on people for a little bit and a lot of people are trying to work out. Are there ways for me to add value virtually to my customer base or to my clients?” Did you innovate on that at all or did you find ways that people were able to get any benefit without having to be hands-on with a practitioner?

Jessica Drummond: Yes, to some extent. So, our practice leads with health coaching and clinical nutrition. But because many people on my team are also physical therapists, we do have a lot of perspective on that, and we certainly do education. Because we started the clinic literally in March of 2020, simply because of demand, part of it was because the elective surgeries shut down and are still struggling to come back up in some areas because there’s not the hospital space for elective surgeries. Physical therapy was no longer in-person. So, our team often collaborates with physical practitioners on the ground and wherever the client lives, whether that’s a surgeon or a physical therapist, and many of those physical therapy practice went virtual.

We could do some of the education. I actually did an educational training program at that same time teaching physical therapy practitioners how to do essentially physical therapy via education, via teaching clients how to do more self-assessment of pelvic floor tightness, how to use Zoom and FaceTime to at least get their eyes on their clients without feeling like they had to be there.

Then the other thing that our practice did and that I did teach physical therapists, and some of them took it and ran with it, is that we started using fitness trackers. Primarily we used Garmin vivosmart® 4, which was a watch that would monitor sleep quality. HRV was huge. That was probably the biggest metric that we used. And that would help us to really have some objective data about those strategies we were using to optimize parasympathetic activation, but also it could help people see if their emotional stress was linked to any physical tightness, like literal physical musculoskeletal tightness, and if days of poor sleep resulted in more pain. So, it gave our clients and ourselves a dashboard to be able to really track sleep quality, stress resilience and movement.

And then the physical therapists would often do video education for exercises. I utilized a lot of YouTube video training that was completed by physical therapists to teach people safe exercise strategies for this population, especially right around pre- and post-op where you have to be a little more careful.

So that’s how we integrated. We used video chatting software with fitness tracking software either through the Garmin and in some cases, we used Ōura Ring, but same idea.

James Maskell: Okay. I mean, talk about reinvention. I mean, you’ve got the old-style endometriosis care, which is pain management with medication and surgery, both of which it sounds like the long-term outcomes are not that good. Then now you have a full reinvention where everything’s built around health coaching and functional nutrition and adding in all this technology as well as recommending other integrative therapies that people can do at home and then you’re still connected into their medical staff. What does this lead to? Tell us about the outcomes. Is this reinvention of endometriosis something that can catch on in medicine, and what kind of outcomes can people expect when they do this significantly different protocol? I mean, it couldn’t be more different.

Jessica Drummond: Yes. Well, I mean, we still consult with surgeons by and large, but the surgical techniques are much better, and our clients are seeing endometriosis specialist surgeons. They’re not generally seeing your average gynecologist for their surgery. And same thing as you said, we refer collaboratively with other integrative manual therapies and even traditional manual therapy. Some of our physical therapist colleagues are hospital-based or local clinically based.

Our outcomes are really strong. The program, we slowed it down a bit in 2021 primarily because of my own health. I had to take a little bit of a step back. But there was and continues to be no shortage of demand. I assume that we’ll be bringing it back in full force in 2022. The outcomes for our clients were excellent, and we have more data to even show that.

One of the things that we’re looking to do…my husband actually in the midst of all this has been getting a degree in data analytics, and we have collected now data…HRV tracking data, sleep quality data along with our clinical notes around their pain improvements and functional improvements…that we have the capacity to analyze the data on a reasonably large sample of patients, in the neighborhood of 50 to 100 patients. We haven’t done that data analysis to this point, but just having been fully immersed in that data for the last 18 months, I can tell you that it’s strong and it’ll be interesting if we can try to get that published.

James Maskell: Yeah, that’s really interesting to have that data because I know, for instance, that NIH-validated metric for pain is how is your pain out of 10?

Jessica Drummond: Yeah. Yeah, it’s the pain scale. Yeah.

James Maskell: Yeah, the pain scale. So where do you see this going? I mean, ultimately you create a new system for endometriosis, you work it out over some patients, you build a technology strategy around it. What do you think it would take for larger adoption of this into much broader endometriosis populations?

Jessica Drummond: Well, what I have been doing to forward that aim is essentially educating other practitioners, other health coaches, other naturopathic physicians, nutritionists, physical therapists, dieticians. And on small scales, people are replicating the model in small one-on-one practices. I think it’s certainly possible to take it wider in the sense that the model exists now. We could leverage it, and that’s just a matter of building the right team, both management team and clinical and coaching team, and committing to the program.

But as I said, I really don’t see…I think it’s scalable. We would need some investment for marketing and scalability of some of the operations, but I don’t see any reason that we couldn’t scale it fairly significantly, and in either one of two ways. One, by us just scaling the clinic, digital clinic if you will, or teaching others to be able to replicate the model.

James Maskell: Yeah, that makes a lot of sense. Well, look, the reason why I wanted to have you on is because I feel like one is there are so many of these micro niches and I don’t even think endometriosis is a micro niche considering how many people suffer from it. Right?

Jessica Drummond: Mm-hmm (affirmative).

James Maskell: But still, it’s a significant number of people. And ultimately, when you share the difference between what the standard of care is versus what you guys are doing, I can only imagine that people who experience your care feel heard, seen, understood, validated. Because ultimately, they’re really learning, okay, through that functional nutrition lens, where did this come from? How did I go…not what I saw in conventional medicine, which is like healthy, healthy, healthy, healthy, endometriosis—

Jessica Drummond: Sure.

James Maskell: …but more of a pattern by which people get there. And that’s obviously one of the beauties and the strengths. The functional medicine operating system is empowering people with information to help them really understand what is the etiology of this condition in myself? What was happening at the time that the symptoms started? What was driving this pattern?

And I guess I wanted to have you on because I just feel like there are people in our practitioner community who are getting excited about one particular condition, proving out that a combination of functional medicine principles, health coaching, technology can really move the dial in a way that the standard of care doesn’t and then are able to think through, okay, how could this really go to a lot more people?

I guess I just wanted to record this as an encouragement for those practitioners that listen to the podcast to think that we’re still in the very early, early, early adoptive phase of this functional medicine, functional nutrition, root cause approach revolution, and there’s a lot of potential and space for people like yourself to be able to have a really big impact, not just in the clinic that you have and not just in the clinic of the people that you have trained, but ultimately conventional care is probably on the lookout for better solutions. Obviously, there’s a lot of friction that prevents new innovation coming into medicine for all the many reasons that probably most of us understand. But I think more than anything, I just wanted to have you to come and share here because I feel like you probably didn’t realize what you were getting into when you started doing it differently a few years, and now all of this opened up as you followed that thread.

Jessica Drummond: Yes, I think that’s very true. I mean, when I initially started just testing what functional nutrition and a health coaching model could add to pelvic pain care, I really had no idea where it would go. I would say that for the last 12 years or so, I’ve been lecturing off and on at conventional conferences and…because so many chronic diseases, and endometriosis is certainly one of them, doesn’t have a simple one-medication solution. And even while the surgeries are evolving and getting a lot better and are more helpful and more successful, the surgeons themselves are looking for support with helping people recovery fully from symptoms because they recognize that surgery doesn’t resolve all the pain drivers and other symptom drivers. So, I really do think even the conventional world of endometriosis care has been listening to what I’ve been saying for the last decade, and they’re very encouraging.

James Maskell: Yeah, that’s great. What you described there, where 10 patients with endometriosis have very different underlying factors in how they got there, it seems like that’s true with the majority of chronic illness. I mean, I remember hearing that in the autism world 15 years ago when it was like you line up 10 kids with autism and the driving factors behind how they got there is different in all these different kids.

I mean, ultimately, I think we’re going to come to an understanding that the majority of chronic illnesses have underlying drivers in each patient that is different from the person next to them who have the same symptoms, and that’s why this functional approach with all of its personalization and with those unique personalized approaches has to become the standard of care. Ultimately, it’s not really efficient enough to become the standard of care today, and that’s why it’s really cool to see practitioners like you taking advantage of technology to be able to create something that can get great outcomes but can also be efficient enough to move the needle.

Jessica Drummond: Yes. And I think we still have some work to do in trying to create group models in this population. That’s been challenging because of the varied causes and pain drivers and other symptom drivers. We have really utilized a pretty labor-intensive personalized approach for this population, and I’ve tested some group models which haven’t been as successful.

But I do think that trying to continue to iterate in that direction would eventually valuable, at least in a hybrid way because there is… What the positives are to any time we tested group models is there is that benefit of having that peer support in a better way than just patient support groups, which sometimes can devolve without having a good facilitator, and positive movement forward, and focusing on improvements over time but not leaving anyone behind. So, there are some group coaching strategies that I think could be applied to this population, but the whole program might have to be more of a hybrid model.

James Maskell: Absolutely. Yeah. Well, I think that’s definitely right, and I’m glad that there are still things to learn because ultimately that’s the journey that we’re on. So, thank you for sharing about the new model that you’ve created. This year on the Evolution of Medicine podcast our theme is the reinvention of medicine. Last year our theme was resilience because we all had to be super resilient last year because this was a unique situation for many of us. But this year the theme is reinvention because now, I guess, the cards are all on the table for where medicine’s been, and we see that the medicine that we’ve had is not really fit for purpose. So, it’s that theme of reinvention.

So as someone who’s been working with one particular kind of condition for a period of time, if I ask you what does the reinvention of medicine mean to you, what would you say?

Jessica Drummond: I would say that everything we’ve talked about here really can apply across chronic illness. I think having a personalized approach to understanding the physiologic recommendations is really helpful, then overlaying data tracking that people can become empowered by to at least better understand themselves and so we can collect outcomes data that’s more objective, and then combine that with a health coaching model which really takes into account the whole person.

I think if we look at each chronic disease from that lens of personalized clinical medicine combined with data tracking, combined with client empowerment and really keeping the client’s goals at the forefront, I think we have a lot more solutions already available to us than are really being implemented very well in traditional medical models because they’re so siloed. I think there’s a place for that knowledge, but I think if we integrate that knowledge within these newer models that we now have all of the tools for…I mean, we have so many tools…that I think that will push medicine forward more quickly and in a way that more quickly gives patients symptom relief and functional improvement without having to go from silo to silo to silo over a long period of time. And that chronic illness clinician shopping journey takes years.

James Maskell: Yeah. Absolutely. And that’s typical with so many chronic illnesses is that people are just searching for the right diagnosis forever, and then sometimes it’s like, oh wow, now I’ve got the right diagnosis, but then it’s like, well, what’s the prognosis? Where are we going from here? How do we get better? And it seems clear to me that this empowerment, coaching, doing the healthy behaviors, whatever, could be the top of the funnel because ultimately that’s what you’re going to have to do anyway.

Jessica Drummond: Right.

James Maskell: Whether you have endometriosis or whether you have irritable bowel or whether you have Crohn’s or whether you have rheumatoid arthritis, there’s definitely a pathway by getting people to do the healthy behaviors consistently. And that’s why I’ve been so excited about groups and coaching and so forth for a long time because ultimately those seem to be the best practices for facilitating a transformation of behavior.

So, we really look forward to following what you’re doing, and thank you for your leadership and coming on here in the podcast. I’m excited to see where this goes and thank you for contributing to this series on new models.

We’ve been talking all about endometriosis with Dr. Jessica Drummond. Check out her book. We’ll have all the details in the show notes. In the meantime, I’m your host, James Maskell. This is the Evolution of Medicine podcast and we’ll see you next time.

Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening and we’ll see you next time.

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