Podbit · The Peter Attia Drive
Endometriosis presents as a constellation of six types of pain and dysfunction — the six Ds. Each one is often dismissed as normal, and together they explain why women suffer for an average of 6 years before diagnosis. Knowing the pattern is the first step to demanding a workup.
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At 21:10 · chapter starts 18:52
Tomioka frames the typical presentation around the mnemonic of the 6 Ds: dysmenorrhea (period pain so severe that IV medication in the ER is sometimes needed), deep dyspareunia (pain during intercourse at the posterior vaginal wall), dyschezia (pain with bowel movements, especially during menstruation), dysuria (cyclic urinary pain), difficulty conceiving, and dysfunctional chronic pelvic pain lasting more than six months without obvious cycle relation. [1] — Renato Tomioka "Endometriosis presents as a constellation of six types of pain and dysfunction — the six Ds. Each one is often dismissed as normal, and tog…" 21:10 He notes that approximately 10% of endometriosis patients may be entirely asymptomatic, their only clue being unexplained infertility — or, more troublingly, they normalize their pain entirely. Adenomyosis presents differently: heavy uterine bleeding is the hallmark, often accompanied by a painful, enlarged uterus palpable during surgery. Distinguishing the two clinically requires awareness of bleeding patterns (more adenomyosis) versus the pain-dominated constellation (more endometriosis). Uterine fibroids, another common condition causing heavy bleeding and sometimes fertility problems, are introduced briefly as an important differential, classified by their proximity to the endometrial cavity (the submucous types 0–2 being most clinically significant for both bleeding and fertility).
AI nailed Andrew Huberman's vertigo-vs-low-blood-pressure diagnosis because that pattern has been reported millions of times. But every patient's liver is different and data on liver surgeries is scarce worldwide — making solo robot surgery dangerous. The rule is simple: data abundance means AI can help; data scarcity means keep the human in the loop.
Fei-Fei Li's father had liver surgery performed by a da Vinci robot guided by a surgeon. The result: 10 times less blood loss than a typical procedure. This isn't replacement — it's the gold standard of human-machine collaboration, where the human's judgment and the robot's precision combine.
US drug overdose deaths fell from 110,000 to roughly 70,000 — the biggest CDC-recorded single-year drop ever. Men's rates fell 27% in one year, and the steepest decline of all was among 15–24-year-olds, down 37%. The crisis narrative around young men needs to make room for signs of genuine progress.
Kessler thought his grief expertise would protect him. It didn't. When his son David died unexpectedly, he found himself on the floor — and eventually realized that acceptance alone wasn't enough. That unmet need became the sixth stage: finding meaning.
Grief isn't just death — it's any unwanted change. Kessler lectured at Coca-Cola and General Mills not because they had lots of funerals, but because change management is grief management. People who grieve well live well.
Witnessing someone's grief isn't just emotional support — it's an essential act of healing. Kessler argues grief is a severance and connection heals it. But real witnessing has two steps: seeing the pain AND affirming the person's capacity to recover.
Avoiding grief isn't free — it's exhausting. Kessler's beach ball metaphor nails it: pushing a small balloon down is easy, but holding a massive beach ball underwater takes constant, draining energy. Unattended feelings don't disappear; they just consume you.
Most people try to control their environment to avoid triggers. Kessler flips this entirely: triggers aren't problems to manage around — they're a detailed map to your pain and your healing. Every trigger points directly to what needs attention.
Running from pain doesn't leave it behind — it accelerates the chase. Whatever we run from pursues us, and whatever we face transforms us. Both Kessler and Lewis Howes testify to knowing both roads firsthand.
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