Dr. Mari Tassarotti [00:00:00]:

I think it's always fair to, you know, ask someone what our other or or physician what are other treatments. And, you know, if they can't give you any, maybe it's I think it's fair to maybe seek a second opinion and not you know, it's just really people doing their due diligence and trying to do what's

Georgie Kovacs [00:00:18]:

best for themselves. Welcome to Fempower Health. This is Georgie. In this pivotal episode, we explore pelvic congestion syndrome otherwise known as PCS. This is a condition characterized by chronic pelvic pain. No surprise. Many conditions are. And it's arising from varicose veins in the pelvic region.

Georgie Kovacs [00:00:42]:

And we're talking to Dr. Mari Tassarotti, who is an expert in interventional radiology. Prompted by a personal journey and a passion for illuminating overlooked aspects of women's health, this discussion sheds light on PCS's symptoms, diagnosis, and innovative treatments. If you've been navigating unexplained pain, join us to uncover insights into PCS and the hope it offers for many women. Hi, doctor. Welcome to the Fempower Health podcast. It's so wonderful to have you here. And before I have you introduce yourself, I have to tell people how this episode came about. So, I have the luxury of, having inherited varicose veins from my dad.

Georgie Kovacs [00:01:29]:

And I was actually visiting Columbia and was meeting with my doctor, and and he asked, what I did. And I told him I have a women's health podcast, and he's like, we gotta talk about pelvic congestion syndrome. And he started talking about it. And I said, wait, hold on a minute. What? And so immediately, I thought, wow. I've never heard of this. And because of all the things I know of pelvic pain, my fear is, like many conditions, women are going doctor to doctor being misdiagnosed, misunderstood. And what was even more fascinating to me is there is actually a fairly straightforward way to treat this.

Georgie Kovacs [00:02:07]:

So that is why we are discussing it. So before we get into all the details, why don't you give us an introduction and then we can dive in?

Dr. Mari Tassarotti [00:02:15]:

Sure. Well, first of all, thank you so much for having me. I'm really happy to talk about this topic, and I'm glad one of my colleagues was able to kind of bring it to your attention. So I am born and raised in Kaneohe, Hawaii. I wanted to become a doctor after some kind of early experiences with the health care system with my family. I went to medical school. And when you're in medical school, you kinda get exposed to all of these different specialties. And, I am an interventional radiologist.

Dr. Mari Tassarotti [00:02:43]:

Kind of surprised that's what I chose. But the reason I chose it was as I was going through, the different specialties I get exposed to in medical school, I realized I liked a lot of them. I liked pediatrics. I liked OBGYN, oncology, urology, and interventional radiology is really a way that, I was able to kind of help many different patients, young, old men, women, different types of conditions. But, there are specialties that do that. I think really what kind of was the galvanizing event for me for choosing interventional radiology was actually on my OB GYN rotation. There was a woman who, had just had a baby and she was bleeding, and I had this fabulous conversation with her. She was so excited about her brand new baby boy, but all of a sudden, you kinda look up and you see some numbers that are scary.

Dr. Mari Tassarotti [00:03:29]:

You don't ever wanna see blood pressure this low. And, an interventional radiologist intervened upon her and saved her. And I was so relieved, and I just thought that's what I wanna do. I wanna be able to kinda make an impact on people's lives and really be there for them, kind of regardless of the situation. Hopefully, it's not always that type of situation, but an opportunity to help people and especially that patient who I just had developed such a quick, and strong connection with really did it for me. So I pursued the field. I did training, in Boston, and, one of my mentors really I kinda told her this story, and she was also an expert in women's health, fibroids, adenomyosis, and pelvic congestion syndrome, which we'll talk about. And I really, worked with her clinically and got into the research and wrote a lot of papers together.

Dr. Mari Tassarotti [00:04:17]:

And, after finishing training, I came to Columbia, and I've really gotten to work with my great colleagues as well and treat women, who have kind of been down a very long road to eventually be diagnosed with pelvic congestion syndrome and to be able to help women who have you know, they tell me stories about very long workups. It's just been one of the more fulfilling things, in my career so far, so I'm very happy to be here.

Georgie Kovacs [00:04:41]:

What does an interventional radiologist do?

Dr. Mari Tassarotti [00:04:44]:

Great question. So, George, you know, a lot of people don't even know about interventional radiology. So that's one thing. People don't know about public congestion syndrome, but they don't know about interventional radiology. So we are a field, and, we do a bunch of different things, but our defining characteristic, I'd say, is we do minimally invasive procedures using imaging. What that means is we don't make really big incisions. And since we are trained in both radiology and the field of the subspecialty of interventional radiology, we are really good at looking at imaging, whether that's CT, ultrasound, MRI, to really know what we're doing when we do these procedures. And the benefit of minimally invasive procedures is that the recovery is quite low.

Dr. Mari Tassarotti [00:05:23]:

There's no big like, no big incision as I mentioned, and, patients are can be impacted very quickly. So we do minimally invasive procedures. So we aren't necessarily cutting patients open and looking directly at, you know, say bowel or peritoneum. Minimally invasive surgeons, it is a nuance in that. Typically, what that described is someone who can go in things laparoscopically or with tiny, tiny incisions and be using cameras or that type of thing to do procedures, by directly looking and visualizing, you know, peritoneal implants or that type of thing. We use imaging to go, as our guiding tool, typically endovascularly.

Georgie Kovacs [00:06:03]:

So now let's get into pelvic congestion syndrome. So first, why don't we talk about, what it is and and why it's so often misdiagnosed?

Dr. Mari Tassarotti [00:06:15]:

Definitely. So, fundamentally, pelvic congestion syndrome or also known as pelvic venous disease is abnormal veins in a woman's pelvis. You can almost think of it, Georgie as varicose veins in a woman's pelvis. And, what happens is, you know, blood is normally supposed to go in and come out, in through arteries, out through veins is very simple way to put it. But for whatever reason, the veins and the pelvis can, not be functioning normally and taking the blood away. That could be because, you know, they've been stretched out and the blood goes the wrong way or which is called reflux or there could be a compression somewhere that's causing kind of a backup of blood. And when that blood kind of pools in the pelvis, it can cause bloating, pain, just discomfort, that type of thing. So that's fundamentally what it is.

Dr. Mari Tassarotti [00:07:07]:

It's abnormal dilated veins in the pelvis that cause discomfort, pain. 2nd part of your question is why is it so hard to diagnose? Why is it frequently misdiagnosed? Well, the symptoms I kinda told you, I think, really, overlap with many things that you talk about in this podcast. And, they can be quite, vague. They can be almost hard to describe for a lot of women. And additionally, the other conditions that also have similar symptoms are very common. So it's always entirely possible that a woman could have pelvic congestion syndrome and maybe, some type of, and you can also have concurrent endometriosis or, some bowel issue or bladder issue or musculoskeletal issue. So I think there's a lot of overlap that makes it kind of hard. And the last thing is I think a lot of people just don't know about it or don't believe it's real, to be honest, and that's something I think we can talk about a little bit more.

Dr. Mari Tassarotti [00:08:01]:

But those are just some of the sweeping reasons why it can be, difficult to diagnose pelvic congestion syndrome.

Georgie Kovacs [00:08:07]:

Oh my gosh. So, I mean, just listening to you, I my head is just spinning because I just finished the 4, episode series on endometriosis and pelvic pain, more focused on the nuance of endometriosis. But, you know, I think back to even episodes I've done on ovarian cancer, like when you said bloating. You know, there's so many of these women's health and I and by the way, I didn't mean for anyone to think just because you have bloating, you might have ovarian cancer. It just it's just the thing that came to me. But the point I'm trying to make is there's all these, you know, sometimes ex like, varying degrees of seriousness and pain for these women's health conditions that impact so many. And the theme is, you know, it's so hard to get diagnosed. Now, you know, if we were to break this apart, I think about I'm a woman, I go to a clinician, and I have all of these different symptoms.

Georgie Kovacs [00:09:01]:

You know, for ovarian cancer, most people are diagnosed late stage. For endometriosis, I mean, people are debating the treatment, the diagnostics. You know, laparoscopy is laparoscopic surgery is really the only way to definitively diagnose it. And even if you get the surgery, people debate if it's done properly. And so I'm sitting here listening to you. So my head is like, as a woman, how do I navigate this?

Dr. Mari Tassarotti [00:09:27]:

It's important to ask the question, you know, could I also have this? You know, if you've had pregnancies, if you have a family history, I think one of the things we might talk about, what are risk factors for pelvic congestion syndrome? It's something, you know, maybe worth thinking about asking, you know, whoever you're seeing if it's OB. You know, is this something that we could consider and maybe seeing an interventional radiologist to kinda talk about and try and tease apart a little bit more what's going on and if there's something we can do to help, you know, part of that as well.

Georgie Kovacs [00:09:55]:

Right. So then let's talk about the the family history and and maybe some things that could potentially indicate this this is something we should investigate further.

Dr. Mari Tassarotti [00:10:04]:

Overall, it's pretty multifactorial. It's a combination of your genetics, what you got from your parents, and then some kind of exposure environment, if that's pregnancy, estrogen, surgery, or just, you know, doing a lot of things that increase the pressure in your abdomen and can have put stress on your veins.

Georgie Kovacs [00:10:21]:

Interesting. Okay. So here's a a question. So, like, I mentioned that I, have varicose veins. Is that a risk factor? Because, you know, I always think of those as in the legs, but we're now talking about the venous structure in our pelvis, which, like, I mean, I I'm again, I'm so blown away This is a thing we need to to be looking at.

Dr. Mari Tassarotti [00:10:42]:

If you have pelvic congestion syndrome, it can go all the way down to your legs, and you can still have varicose veins, because all the veins are connected eventually. That if your pelvic congestion syndrome isn't addressed, that your varicose veins will have a hard time being addressed as well. So to answer your question, yes, there's an association for sure. I think, you know, some of us are predisposed to have veins that just are a little bit, weaker and more prone to reflux. And I think that doesn't stop at the leg and in the abdomen, if that makes sense.

Georgie Kovacs [00:11:10]:

So have you been able to decipher any sort of nuance in the way women with pelvic congestion syndrome describe their pain?

Dr. Mari Tassarotti [00:11:22]:

One of kind of a classic thing that really gets my, my suspicion for pelvic congestion syndrome or pelvic venous disease up is, a woman who, this is kinda like the textbook type of thing is, has had a couple of pregnancies. Maybe I have to say 2 pregnancies. After the first one, she kinda just felt this, like, pelvic pain and it it got worse. And then she had her baby and just focused taking up taking care of her baby. And still had these symptoms and then maybe got pregnant again. It got worse. But what kind of it's like a dull aching pain in the, kind of lower pelvis that what I think kinda distinguishes it a little bit more from some of the other ideologies is it seems to be worse when you've been standing or doing exertion for a long time and better when lying down. And that's really because, it's similar to kinda like varicose veins.

Dr. Mari Tassarotti [00:12:09]:

When you stand and the blood's going down gravity wise, it pools and it's not coming back up the way it's supposed to be. So if you elevate your legs or put compress we can't really compress our pelvis that well, but you know what I mean? Like, lying down and you can have some sense symptomatic relief. That really piques my interest. I think that is a little bit different than some of the other, ways it manifests. That said, you don't have to have those that exact story, which makes it a little bit confusing. But definitely with that kind of worst one standing for long periods of time or exertion and really feeling better after lying down, that's the that's kind of the thing that really gets my ears up, I guess.

Georgie Kovacs [00:12:44]:

So when when people come to you, I mean, I'm so curious of of the different flavors of how people get to you. You know, are you finding that this is one of the, you know, conditions where it's a little bit more understood, or is it because of the symptoms being what they are, you're seeing patients, like, you're probably the 10th doctor? Like, what what's the journey that you're finding?

Dr. Mari Tassarotti [00:13:08]:

They come do their own research, and I applaud those patients. And they kind of, you know, find us through their own research, and then they, come and see me and we kinda talk about, you know, what they've, who they've seen so far. And there are this there I have you know, it's not uncommon to the story. Like, I've seen a couple of, physicians, typically OB GYN, gastroenterology, plus minus neurology, and sometimes orthopedics because there you can also get back pain from this. And, you know, I just wanna make a little I think it's important that, you know, one thing about our field intervention radiology is we pride ourselves on being very multidisciplinary nature. I would like to work with other colleagues and make sure that you know. We are providing the best care, so I think frequently, you know, just because you've seen other physicians, it doesn't it can be tough, but I think together, at least in my practice, we're very, keen on just providing the best care and really kind of figuring out what's going on.

Georgie Kovacs [00:14:02]:

Yeah. No. Absolutely. Now what about so, again, you know, I just recently interviewed, pelvic floor physical therapist, and I know finally we're talking about the pelvic floor. There is a lot of startups that are focused in this area. 1 of my, multi appearing guests is expanding around the states, which is wonderful to hear. Do you find that like, I'm assuming they have a pretty good sense of pelvic congestion syndrome as well, and I'm sure there's some elements of collaboration with them. I'm curious of that that dynamic.

Dr. Mari Tassarotti [00:14:36]:

Yeah. I think, you know, we, I will say our kind of contact point between them is tends to be OBGYN, and I think there's a lot of overlap with women who have pelvic floor conditions who might also have this in it. I think this is my very current theme. Like, there it it's so common, and there's so many other things that are common that overlap with it that I think that they do have a good sense of it because especially if it has that kind of characteristic I mentioned to you in terms of in better with lying down or standing up, it really it that is a little bit of a kind of special or kind of, unique aspect, I think of it. But I think that, you know, kind of attacking, lack of better order, addressing pain from multiple, modalities and multiple angles, I think, is really effective.

Georgie Kovacs [00:15:21]:

Right. So so I'd love to jump to the treatment because this is one of the few things where it's, like, fairly straightforward, if I understand it correctly. So I don't know if there's one treatment option or multiple. So can you talk us through that journey of you suspect it? I assume it would be suspect it, and then you have to do certain things to verify, and then you do the treatment. So walk us through that during Exactly.

Dr. Mari Tassarotti [00:15:45]:

Sure. So, you know, when I get a referral for, or a patient I see for the first time for consultation of pelvic congestion syndrome, really the main thing for me is really getting a detailed history. And that really goes you know, I think that goes for everyone, but you really wanna know what are your what are your symptoms? How are they affecting your quality of life? What makes it better? What makes it worse? And who have you seen so far? Like, what has been ruled out? Because, as I mentioned, it's very there are things that we really wanna make sure are addressed as well if they're also happening or haven't been kind of addressed. So assuming that and I still you know, I'm suspicious or we wanna make sure that if there's public congestion syndrome that we address it, next kind of step for me is, imaging. We're interventional radiology. We need our imaging. There's different practices and different ways people practice across the country, but I think a lot of people really like to go with an MRI. A lot of patients come in with an ultrasound, OB GYNs.

Dr. Mari Tassarotti [00:16:40]:

People only get ultrasounds are performing themselves. So I think an MRI gives us more information, and we do MRIs, or I typically like to do MRIs that really look at the veins. They can kinda show us areas of compression, or areas of reflux or dilated abnormally enlarged veins. So once you get the MRI, I like to review that with the patient to kind of, show them, you know, what exactly, is likely the veins or why the veins are, causing issues. And that really helps, kinda go through the treatment plan. Ultrasound, is a great modality. It really gives us really great information about the pelvic organs, like the uterus, the ovaries, and it's, a relatively short it's not as long as some of the MRIs we get. Right.

Dr. Mari Tassarotti [00:17:26]:

The downfalls are they're not as good. They it can be, but it's very, dependent on who's performing the ultrasound, the technologist, or the protocols at any given institution for looking at the veins, which is really what's important, for pelvic congestion syndrome. So that's kind of the difference where I think MRI really has an added benefit at least. You know, that's my personal practice pattern, because you can really kind of see in very great detail, veins that go all the way up to kind of the level of the kidney. It's you can't really see that on ultrasound very well, all the time. Some people you can. Some people you can't, but, you know, MRI really helps with that. In certain protocols as well, you can also see if there's kind of reflux or abnormal flow, similar to, you know, ultrasounds you might get for varicose veins.

Dr. Mari Tassarotti [00:18:15]:

So, but also on an MRI. So that's why I think MRI is helpful. It just gives us that added information that really focuses on the veins. I will be honest. CT can also do that, but I think, MRI, it just is better in my opinion in terms of the detail.

Georgie Kovacs [00:18:30]:

Yeah. So then what about the treatment modalities? You mentioned that there is multiple. So tell us more about that.

Dr. Mari Tassarotti [00:18:35]:

I just wanna, you know, be completely transparent. There are medical therapies that are can be effective for a small subset of patients, which are usually hormonal based, you know, there's some data that they help and but for to be honest, for a large subset of patients, they don't provide enough relief, that patients are satisfied. So then there are interventions, and they can be with interventional radiology or surgery. You know, kind of the biggest thing that surgery can do is kind of do a hysterectomy nephrectomy to kind of remove the ears and surrounding veins. Yeah. That's kind of, not frequently done because I'll talk about what we can offer as well and that's quite effective. The other thing is, surgery can also live eat or, take out veins that are causing problems or refluxing as well. So that's kind of the surgical options and, you know, they require incisions and little bit long in general anesthesia.

Dr. Mari Tassarotti [00:19:25]:

So they're a little bit on the longer side in terms of recovery. What we can do in interventional radiology based on what, you know, looking at the MRI, your symptoms is through, using small catheters and wires. We enter the vein either in your neck or in your groin, and the incision at the end is, like, very small. Using live X-ray, we kind of go into the veins that we're concerned about, and we take some pictures, can get measurements. So if a vein is refluxing or blood is going the wrong way, what we can do is we can kind of take it out. We can embolize it or sclerose it. And that's quite effective. We typically do that in the a vein called the gonadal vein.

Dr. Mari Tassarotti [00:20:03]:

It's very commonly sending blood the wrong direction. For patients who have compressions, which are basically their vein is being squished by something, typically an artery that's going across. We take pictures and we can put a stent in there to to really open that up to help the flow go the right way and not back up into the pelvis. So there are a couple of options, but they're all pretty much done the same way, which is through a small kind of pinhole in your in the vein in the neck or leg.

Georgie Kovacs [00:20:30]:

So question for you about the hormone therapy because I know that you were, alluding to something earlier today, and I just recently did an interview with an OB GYN who specializes in menopause. And we talked a lot about the changes that happened to our body. And I teased her. I'm like, are you gonna tell me that every single woman in this needs to take estrogen and everything will be gone? Because we even go through each of the symptoms. And, it was like be it's because of the estrogen changes. So, you know, do we is it also the case that with pelvic congestion syndrome that because of our hormone levels changing as we age, that this is one of the things that could be impacted our are venous structure and or or is there not enough data to talk about what happened?

Dr. Mari Tassarotti [00:21:18]:

It's a little bit hard. I think, you know, it's really the the hormonal changes of pregnancy that seem to do, have their most effect on in addition to, you know, there's just so much more blood in pregnancy that's a lot more stress on the veins. So it's really hard to kind of pinpoint how much one is contributing to the other. But the reality of veins is as you kind of stretch them out, they have valves in them that help prevent blood from going backwards. As you stretch them out and you stretch out that valve, veins are kind of unforgiving that they don't always kind of snap back and you can keep stretching and stretching and they get kind of more or less get worse. And, changes in hormones don't necessarily help them go back to normal, if that makes sense.

Georgie Kovacs [00:21:58]:

Okay. So you were mentioning the hysterectomy. So I'm actually doing an episode on hysterectomies so that people know how to advocate for themselves. And, you know, it was like the first example you gave of what may need to be done. So in in what cases would it be that a woman should consider the hysterectomy? What might lead to needing that.

Dr. Mari Tassarotti [00:22:32]:

I would just say kind of, and it might be a little bit biased in terms of the type of patient that I eventually see. They're pretty hesitant to get, surgery. I think one of your prior, speakers kind of talked about a particular type of, patient who just doesn't really wanna have a question of is this gonna are the veins ever gonna come back? I you know, is this if we just take out the veins, is this gonna be the, kind of final, or the most definitive solution? But that said, I know I talked to a lot of women who have been offered hysterics for various conditions, fire boards, that type of thing. And I've you know, I just hear kind of the story, like, and this feeling over that, you know, it they find it upsetting to have to even if they don't wanna have children anymore. And I I can definitely, understand that. So they think they often ask if there's a way to kinda you know, maybe down the line, things get bad or this doesn't improve, Maybe, but I wanna try something else before I get there. And they ask us, you know, ask intervention reality, is there something you do? So that's I think I feel like that's where we kind of come in. But, you know, the recurrence rate after these interventions, you know, if they're successful and they have a pretty high success rate.

Dr. Mari Tassarotti [00:23:43]:

And what I mean are interventions, interventional radiology is upwards of 80%. But there is a 5 and so 80% of patients really have marked symptomatic improvement. 5% of those patients will have some recurrence. And if and we there's a way we can kind of address and maybe do another intervention, but maybe there's a certain type of, patient who is just like, I don't wanna keep going through this. Maybe if I just go through that. But I'll say it's pretty uncommon Okay. At least in my experience, but I I I will admit I do have a little bit of a, bias in terms of the patients I see and that that feeling and sentiment that they express.

Georgie Kovacs [00:24:18]:

Are there cases where maybe the hysterectomy is the option because it isn't an interventional radiologist who recommended it and who got involved, and perhaps the hysterectomy was done without people knowing the option that there's probably something more minimal that could be done. I mean, is that I guess, is that real? Is that a possibility?

Dr. Mari Tassarotti [00:24:41]:

That's definitely a possibility.

Georgie Kovacs [00:24:42]:

Even putting pelvic congestion syndrome aside, would it be fair to say that an option for people who are struggling in their pelvic area, if hysterectomy is the option given and it could be dependent on the condition, would it be wise, generally speaking, for women to seek the counsel of a minimally invasive surgeon slash interventional radiologist just to get another perspective on what might be happening in that pelvic region?

Dr. Mari Tassarotti [00:25:17]:

I think it's always fair to, you you know, ask them what our other or or physician, what are other treatments? And, you know, if they can't give you any, maybe it's I think it's fair to maybe seek a second opinion. And, you know, I don't get offended if patients ask, you know, how many they're gonna seek a second thing. I think it's just really people doing their due diligence and trying to do what's best for themselves. So I think depend depending on the situation, but if there's a hysterectomy, that's it. I think it's worth kinda seeing, someone else to see what other options there are because there are a lot of other options.

Georgie Kovacs [00:25:49]:

Obviously, if someone needs it or wants it, that's one thing. But if there's something like a pelvic congestion syndrome where there's a fairly straightforward procedure, so it almost seems like a question women should ask is, what are the alternatives? What are my options? Right?

Dr. Mari Tassarotti [00:26:05]:

And I think the sad part of I think I think you and I both are kind of alluding to the the sadness of maybe someone making a decision without having all the options laid out to them. That's tough. That's that's tough time to go something big like that. Not having not known about other alternatives that they may that may have been better for them or may have been more aligned aligned with what their desires are. I think that's, you know, a tragedy in some in us Yeah. In a way.

Georgie Kovacs [00:26:28]:

I mean, if honestly, if I had my druthers, I would, like, completely redo how our health care organizations are structured and even the patient journey and how they're navigating to the different clinicians. I know some startups are trying to do that in in certain respects, and I hope they succeed and then can continue to expand into other areas because the systems thing really creates a challenge for the clinicians who are trying to help and the patients who are seeking that help. It's just it makes it tough. Yeah. So for this, like, they get the the procedure. Let's assume this is the procedure that that is done with the interventional radiologist. What happens after?

Dr. Mari Tassarotti [00:27:04]:

Sure. So, you know, the way that this procedure is done, it's done as an outpatient elective, procedure. So you'll come in, and during the procedure, you'll get some sedation, through your IV. You won't be, you know, there won't be a 2 down your throat type of surgery. It'll be, you know, some medication to help take away any pain, to kind of take the edge off some anti anxiety. It's sedation. You know, some patients watch the screen, or take a nap, that type of thing. Afterwards, when we're done with intervention, you kind of come into our recovery area.

Dr. Mari Tassarotti [00:27:37]:

We there I our practice is you kinda stay flat just to reduce any bleeding from the puncture sites, which are very small again. For about 2 hours, we wanna make sure that you're able to eat and drink, you know, normally after receiving some of these medications to your IV and patients go home the same day. Kind of, you know, things I tell patients to look out for. You might have a little bit more pain than you're used to for the 2 weeks or not. I'm sorry. 2 days to 1 week after. And, you know, that's kind of, just we put something in your vein that there's a little bit of inflammatory response that's really effective. We, addressed with Ibuprofen or NSAIDs.

Dr. Mari Tassarotti [00:28:14]:

I tell patients take it easy for a week. You know, some people really like to exercise. It can be hard when you have kids at home to try to have a little bit of extra help just to kinda take it easy for about a week. But people can generally, you know, get back to light activities the day after type of thing like that.

Georgie Kovacs [00:28:28]:

If I remember correctly when I first heard about this condition, if I'm not mistaken, there isn't an official diagnosis code for this, and it has to be code in a different way because people don't necessarily believe it's a thing.

Dr. Mari Tassarotti [00:28:39]:

Yeah. So I this is a little bit of, a tough question. I think we're kind of on shifting ground a little bit. They're always updating codes for this, and it it can sometimes be a little bit tricky with the insurance companies reimbursing kind of this. And it really alludes to kind of a lot of what you're saying in terms of there isn't necessarily a, diagnosis code that gets approved all the time, and sometimes we have to use alternative codes which are still a 100%, you know, accurate of what's going on. It just leads when that happens though, it leads to confusion amongst multiple people, which makes makes it tricky.

Georgie Kovacs [00:29:17]:

Yes.

Dr. Mari Tassarotti [00:29:19]:

One thing I, you know, I find is I interesting about and kind of unfortunate about pelvic condition syndrome is I'm a little bit of a history nerd, so there's actually kind of a history to this. What's been unfortunate about pelvic congestion syndrome or pelvic venous disease is tetalog name changes. Kind of some rebrands and when you get to I mean, I feel like you probably know this.

Georgie Kovacs [00:29:42]:

I did not know about the rebranding. Let's

Dr. Mari Tassarotti [00:29:44]:

talk about the In general in general when that happens, people kind of I feel like you can't I don't think there's an inherent bias to it loses a little bit of legitimacy or kind of people kind of forget about it like what is it called? Is it that or this? So, you know, it was originally I kind of first described in way back in 1949. It was called congestion fibrosis back then. And as we've kind of evolved as a medical field to figure out more about what it is, it started be to become called pelvic congestion syndrome. And then there were these other, diseases that we kind of knew about such as May Turner, which people are not. Well, that's actually pelvic congestion syndrome. And more recently, it's so you can see the confusion here that you really you know, I think

Georgie Kovacs [00:30:29]:

I have a marketing person. I could probably hire. I know. Now the question is, who who owns it? Is it the informational radiology division that owns the branding of what this is, you know, and so and

Dr. Mari Tassarotti [00:30:40]:

so. Exactly. And so I think there's it's one of the known issues with, and it's just an unfortunate function of its history. It's renaming things kind of being added to it under its umbrella, which makes it, it leads to a bunch of problems like like this in terms of coding, insurances buying into it. Like, we just change the name. Like, what are you know, I think in every as you know, every process and thing like that takes time to change and catch up. So that's I said it's something that, we as a field know about and really working on standardizing the language, getting diagnostic criteria, getting the data. It's one of the big, research kind of, priorities in the society of interventional radiology because there's just so much confusion, which is confusing to clinicians, patients, payers, that type of thing that there's a lot of room to improve here.

Georgie Kovacs [00:31:28]:

Oh my goodness. No. I mean, it makes a lot of sense. And and again, it's all context, like, to the person who's struggling. It's like, hello, people. Just code it and just pay for it and just diagnose me. And to the people who are doing a million other things, it's like, yeah. But on my plate, I have x, y, z, and a, b, c, d, e, f, and so I hear you, but.

Georgie Kovacs [00:31:51]:

So welcome to our

Dr. Mari Tassarotti [00:31:52]:

healthcare system. No. But I think definitely we're we're working on it because I think we do want you know, I think we wanna kinda streamline diagnostics. We wanna really, you know, figure out what's the best treatment, best agent to embolize to really help women. So I think we've come a long way. It's kind of resulted in a history that's made, things a little complicated in our current situation, but there's still a lot of efforts underway to try and really improve this and, help a lot of women. I mean Yeah.

Georgie Kovacs [00:32:16]:

All of it

Dr. Mari Tassarotti [00:32:16]:

chronic pain is a big problem, and a large subset of that, as you mentioned, is unknown.

Georgie Kovacs [00:32:21]:

I would say, like, what's been your the cleanest scenario that a person's come to you?

Dr. Mari Tassarotti [00:32:26]:

It's hard. It really is hard. Because I think we really don't want we don't wanna miss cancer. So I think we get a lot of diagnostic testing. We don't wanna miss someone who has Crohn's or something that's really serious that we should really address as well. So I think there is gonna be some diagnostic testing, but there are various do OBGYNs, other, question to get some of that initial diagnostic imaging and they kind of doesn't fit the bill for a lot of the things that they're concerned about, which is good that those have been ruled out. But maybe on imaging, they saw kind of a weird, vessel or kind of the symptoms, or they had another patient that is treated by anoreventral radiologist who's very similar and gets referred. So I think I I have encountered that, but doesn't mean that they still didn't undergo a lot of other diagnostic testing.

Dr. Mari Tassarotti [00:33:11]:

But we're able to really, so yeah. Just to talk about, like, a clinician story. I took care of a woman who's about 45 years old. She, had 3 kids. So after her second pregnancy, she, during her second pregnancy, I'm sorry, she started to have pain. And she's like, oh, I'm I'm pregnant. This is kind of part of it. And then she gave birth, and she still had these symptoms, which we're new from her first pregnancy, which was so busy taking care of her kids and she kind of soldered through it and thought, you know, this is maybe this is just how things are, but it was it really affected her quality of life.

Dr. Mari Tassarotti [00:33:43]:

And then she had a 3rd kid and it then she continued to have it since they actually got a little bit worse, and her OB GYN, had seen her. And, you know, she had been ruled out for malignancy, and some of the bowel issues. But, really, she had that kind of classic history of really, having some fullness that was really worse. I think she worked, she works in a day care actually. So a lot of walking around, standing up, running around, and then at the end of the day, it just felt much better. And we were able to get some imaging that really showed a large pelvic veins and a vein that we were able to embolize, and she felt fine. Really much a lot of improvement after 1 month, and then get continued for 6 months. And what I just found inspiring about her story was she's like, well, I didn't I didn't think I'd ever get back to this because she had kind of thought, I had kids.

Dr. Mari Tassarotti [00:34:33]:

This is this is my life now. But, you know, she, she got to us pretty quickly, and I think she was appropriately worked up. I don't think that's really important too. But that's one of the the those types of stories kinda being interested in the field and wanting to be better.

Georgie Kovacs [00:34:50]:

That is awesome. Any words of wisdom that you may have for your health care professional colleagues? And it sounds like OB GYNs are probably the the key here. Anything that you would love to share, with them as they're seeing these women with complex systems?

Dr. Mari Tassarotti [00:35:08]:

Having a relationship with an interventional radiologist, at your institution or your local practice or in the area is always very helpful to keep, pelvic congestion syndrome or pelvic venous disease on your differential. And those medical professionals, when a patient comes in, we have a list of things that we think are more likely and sometimes just due to lack of awareness, doesn't make the list and then it kind of eventually comes up. But having that kind of early on, just given its frequency is, something that can help. And, interventional radiology colleagues are always here to help, so feel free to reach out.

Georgie Kovacs [00:35:40]:

Oh my gosh. Well, I I feel like we need to collaborate on a tip sheet for for women on this one. Fascinating. Absolutely fascinating. But thank you so much. And is there anything else, by the way, that you wanna share? Maybe I didn't ask you a

Dr. Mari Tassarotti [00:36:03]:

you've asked some of your other guests, you know, how can you find someone, if you're a patient and you think I have this and you just wanna find an interventional radiologist? You know, we have a website, the Society of Interventional Radiology, and I I shared the link. And you can actually look up, interventional radiologist based on country, state, and conditions that they specialize in or have a special expertise. And pelvic congestion syndrome is one of those drop down options.

Georgie Kovacs [00:36:28]:

Awesome. Well, thank you for your dedication to this. Of course.

Dr. Mari Tassarotti [00:36:31]:

Thanks for doing this.

Georgie Kovacs [00:36:33]:

Yeah. No. Absolutely. I really appreciate you making time, and I can't wait to share this with folks. And I'm I'm curious if people will be as shocked as I am because I was like, wait. What? Something like, usually, it's we don't know how to diagnose, and we don't know how to treat. And now this is like, we actually have a diagnosis, a way to diagnose. We just have to get to the path to get there, and, oh, we can treat.

Georgie Kovacs [00:36:54]:

So this is like a dream, in some respects, a dream symptom. So Well,

Dr. Mari Tassarotti [00:36:58]:

I hope some people find it helpful.

Georgie Kovacs [00:37:00]:

Yeah. Absolutely. Thank you so much.

Dr. Mari Tassarotti [00:37:02]:

Of course. Thank you so much for having me, Georgie.