Podbit · The Peter Attia Drive
Without post-surgical hormonal suppression, endometriosis recurs at roughly 10% per year. A Mirena IUD inserted after surgery cuts that recurrence risk by 88% compared to placebo. Surgery alone is a temporary measure; the disease is chronic and demands a lifetime treatment plan.
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At 52:20 · chapter starts 45:52
The first case study grounds the episode's treatment principles in a real clinical scenario. A 20-year-old in pain who wants to preserve fertility but not conceive now faces a structured set of questions: Does she want children? How many? What is her ovarian reserve? What is the disease phenotype — importantly, does she have an endometrioma? How severe is her pain? [1] — Renato Tomioka "Mirena after surgery cuts endo recurrence 88%: Inserting a Mirena IUD after endometriosis surgery reduces recurrence rates by 88% compared …" 52:55 Tomioka explains the logic for each option. Mirena IUD is excellent for five years of progesterone-mediated suppression but does not suppress ovulation, so it cannot control endometriomas, and it is contraindicated if myofascial pain (pelvic floor muscle tension) is present. Combined oral contraceptives are the most common first line, with a preference for the lowest effective estrogen dose to avoid stimulating lesions. Progestin-only pills (norethindrone, dienogest, desogestrel) are an alternative. If she fails to respond at 3 to 6 months, the medication changes or surgery is considered. Surgery is not first-line because it is very likely she will recur within 5 years unless a hormonal agent is used post-operatively — and a Mirena IUD placed after surgery cuts recurrence by 88% vs. placebo. [2] — Renato Tomioka "Without post-surgical hormonal suppression, endometriosis recurs at roughly 10% per year. A Mirena IUD inserted after surgery cuts that rec…" 52:20 The overarching frame is that endometriosis must be treated as a chronic disease requiring a life-plan, not a single intervention.
Inserting a Mirena IUD after endometriosis surgery reduces recurrence rates by 88% compared to placebo, highlighting the importance of post-surgical hormonal suppression.
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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