Endo Excision for All

Hi, I’m Hannah, and I have been living with endometriosis symptoms since I was 11. My first period lasted six months, and from that moment on, my life has been dominated by pain, fatigue, and uncertainty. My periods were unpredictable and excruciating, but I was told they were "normal" by peers and doctors.

At 19, while at college, a new provider prescribed a form of birth control that my body completely rejected. It caused continuous, heavy bleeding and left me on total bed rest for 13 weeks, attending classes from my bed, unable to leave my dorm, and living day-to-day with constant pain. The number of times I facetimed my mom just so I wouldn't be alone when I would inevitably pass out in the bathroom is more than I can count using both my hands and my feet. Those facetimes felt frighteningly routine at that time.

Endometriosis doesn’t just hurt during periods — it controls every part of my life. My periods usually leave me bedridden for the first few days, on top of other excruciating symptoms that make even the most mundane tasks unbearable — eating, sleeping, going to the bathroom, walking. I spend nearly 22 hours a day with a heating pad on my stomach. I have missed birthdays, weddings, and trips. I plan my life around my pain, not the other way around. On my worst days, it feels like someone is carving me from the inside out, leaving me drained, fragile, and desperate for relief.

I have been so fortunate to have the same incredible people rally around me since I was first diagnosed. Their support has meant everything. But I’ve also lost people along the way — friendships and connections that couldn’t survive the inconsistencies my pain causes. That loss has been isolating, reminding me that endometriosis affects not just my body, but every part of my life.

After five years of waiting, I was finally able to see an endometriosis excision specialist. He performed a mapping ultrasound to fully understand the extent of my disease. The results were sobering: a cyst on my right ovary, my right ovary stuck to my bowel, my left ovary adhered laterally to my cul-de-sac, endometriosis on both uterosacral ligaments and my torus uterinus, a nodule on my lower rectum (which will require a bowel resection), and superficial endometriosis on my rectouterine pouch. This mapping confirmed why expert surgical care is absolutely necessary.

I am now preparing for my fourth surgery in five years, this time with this specialist. The procedure will include a laparoscopy, laser excision, hysteroscopy, and bowel resection, scheduled for May or June 2026. This surgery is my lifeline — my chance to reclaim my life, wake up without pain, and move through a day without fear of flare-ups. I want to go to work, socialize, travel, and finally feel at home in my own body.

Insurance will not cover this surgery because I’m seeing a specialist, and the cost totals $14,500. Every donation, share, or word of encouragement brings me closer to a life free from constant, debilitating pain — a life I have been dreaming of since I was a child.

I’d like to thank the donors in advance for helping me prepare for a very important and life-changing surgery.

My name is Ashleigh, and I seek support, amongst many, in endometriosis excision surgery. Working in the medical field, I was always seeing and caring for patients who battled or have battled through different diseases and disorders.

It’s one thing to be the support and smiling face patients need every day, on the sidelines cheering them and their families on through challenging times, but it is another to now be on the receiving end of that. I always hoped this day would never come for me, but this has become my new reality.

After gaining a deeper understanding of endometriosis, I hope we can raise awareness of the severity of this full-body disease.

I am now realizing that this is actually something I have lived with and pushed through for over 10 years. The level of pain I’ve endured, the debilitating migraines, the gut issues, excessive weight gain, and food sensitivities only scratch the surface. Learning that my body not only feels it is in constant emergency but also doesn’t feel safe to bring life into the world is extremely mentally, emotionally, and spiritually taxing. It has robbed me of my joy and sometimes my will to keep moving forward.

Excising endometriosis is the gold standard, and surgeons in America are worthy of receiving proper education to perform excision, thus appropriate payment from insurance companies for their excellent service and dedication.

Currently, I am barely able to afford my acupuncture treatments to help manage symptoms in the meantime because insurance does not cover these treatments. Thanks to my acupuncturist, I’ve been able to find one of the very few surgeons in the country who excise endometriosis rather than ablate. However, I am left with the out-of-pocket costs that insurance refuses to cover.

Your donation in any amount is truly a blessing and makes a difference not only in my life but in others and those to come.

With more life,

Ashleigh

My journey with Endometriosis began at just 10 years old, when I first got my period. As a child, I suffered through heavy bleeding and agonizing pain that doctors dismissed as “normal.” I was diagnosed with Precocious Puberty, and I was placed on a drug called Lupron, which stopped my periods completely for a few years and in effect, it put my body into early menopause as a little girl. When the medication ended, the pain returned, and I was put on birth control to try to manage the symptoms. For years, I lived with severe pain, bloating, heavy periods, and exhaustion, but no real answers. Doctors continued to insist it was “just part of being a woman.

In 2014, I had surgery to remove an ovarian cyst, and that’s when my OBGYN discovered and lasered some Endometriosis. He gave me very little information and made it sound like something I would live with forever. After that surgery, my body went into cycles of debilitating flare-ups. The pain was so intense that it pushed me to start researching Endometriosis for myself.

Through that research, I found an online support group full of women and medical professionals who truly understood this disease. For the first time, I met people who knew what I was going through. It was in this group that I learned about excision surgery, the gold standard treatment. I also learned that there are very few true Endometriosis specialists in the country. Most OBGYNs only perform ablation, which burns the disease but doesn’t remove it from the root, exactly what was done during my surgery in 2014.

In 2019, I had my first excision surgery. It brought relief for a while, but not full healing. Endometriosis is not just a reproductive disease; it’s a whole-body disease with deep inflammation. During my surgery, they discovered the disease not only in my reproductive organs, but in other areas of my body as well.

Over the past several months, my pain has returned and become intense and constant. It affects every part of daily life. Even though I am naturally joyful, I am living in severe pain every single day. Simple things like walking, standing, sitting, and even getting out of bed are becoming harder. My brain fog makes it difficult to focus. My “endo belly” stays swollen and painful. Even wearing clothes hurts. Pain medication doesn’t help.

Emotionally, this has been one of the hardest seasons of my life. I cry often, I cancel plans, and I feel like I’m letting people down. I don’t feel like myself. And yet, I hold onto my faith. I know that Jesus is close to the brokenhearted, and that He sees my suffering and will not waste it. Holding onto hope is sometimes the hardest part but I keep trying.

A few months ago, I saw a friend share about her successful excision surgery with a specialist in New York City. I reached out to her, then to her surgeon, and after speaking with him, I finally felt something I hadn’t felt in a long time: hope. His success rate, his technique, and his low recurrence rate gave me confidence that this is the best path toward healing and a better quality of life. On December 18th, 2025, I will be having excision surgery with Dr. Kanayama at the New York Endometriosis Center.

Due to large out-of-pocket expenses for this surgery, I have done everything I can on my own, and now I am bravely and humbly asking for help.

How funds will be used:

• Specialist surgeon and hospital fees

• Travel and lodging for surgery and recovery

• Post-operative care and medications

After surgery, I will continue using my voice to bring hope to women walking through this disease and to educate others about Endometriosis. I will keep advocating, and I pray that in my lifetime, alongside the 1 in 10 women affected, we will see a cure.

Any support, donations, sharing my story, or prayer would mean more than I can express. I am trusting God for healing, restoration, and the chance to live without constant pain.

Thank you for reading, caring, and standing with me in this difficult season.

With love and gratitude,

Ticalle

Hi everyone, my name is Rachel Warren and I am a 25 year old dog mom, baker, teacher, girlfriend, daughter, granddaughter, aunt, sister and many other things. Ever since I was 12, I knew something was wrong with me. I was never completely sure what it was, but I was always more tired, in pain, and struggling with weird symptoms. I struggle to this day with a range of symptoms from absolutely miserable menstrual cycles, to crippling exhaustion, and debilitating joint pain. This disease has taken away my ability to work full time, due to having to go to the bathroom constantly, dealing with bone deep excessive exhaustion, severe bloating to the point that I have bigger clothes to wear at these times, UTI symptoms (without it being a UTI), migraines, severe back pain, hot flashes, constipation and diarrhea, dizziness, and so much more. Endometriosis is a horrible, debilitating disease that has completely changed my quality of life, and decreased it severely. Not only does this disease impact my ability to work, but it takes away from my ability to spend time with my loved ones, play with my nieces and nephews, and go on hikes with my dogs.. Those are just a few things I often can’t do.

Despite many doctor visits, every doctor I saw insisted nothing was wrong with me. I recall one time when I went to the ER because the pain in my abdomen was so bad that I couldn’t function. I was bleeding incredibly heavily, in intense lower abdomen pain, and having UTI symptoms. Instead of compassion or help, I had an extremely painful transvaginal ultrasound, and then the doctor told me that I was fine, and I simply had a low pain tolerance. I was sent home with a pamphlet on period cramps, with nothing for the pain.

In 2022, I finally found a doctor who was willing to listen to me and thought that something might actually be wrong. In 2023, I had a laparoscopic surgery where they found endometriosis on my right ovary and on my bladder, as well as a fibroid. Endometriosis is a chronic condition in which cells similar to the endometrium grow outside the uterus and still respond to hormonal changes. They performed an ablation, which is actually an outdated surgery method that can cause more damage than relief. I had a few months of relief from some symptoms after surgery, but then my symptoms worsened. I deal with uncontrollable weight gain and loss, migraines, joint pain, excessive urination, bladder pain, abdominal pain, hip pain, nausea, vomiting, constipation, diarrhea, severe bloating, severe exhaustion, and more. I have found some relief through diet change as I went dairy free and grain free, as well as several different therapy methods. However, I ultimately need another surgery, using the gold standard of care for endometriosis, which is excision surgery. In September, I was able to find an excision specialist in Washington state, who is qualified to perform the surgery I need. When I visited this doctor, she also diagnosed me with adenomyosis of the right ovary and suspected interstitial cystitis. Adenomyosis is when the endometrium tissue grows into the muscle wall of the uterus, and interstitial cystitis is a chronic condition that causes pain and inflammation in the bladder.

This surgeon determined that I do need excision surgery to remove the endometriosis that was burned during the ablation,, as well as any new growths they may fin.. Unfortunately, it would be completely out of pocket, as well as any costs associated with the surgery, which could be over $20,000. I did find another surgeon who is a possibility as they accept my insurance. However, I would have to travel out of state, and would still have out of pocket surgery costs. Insurance would help, but I would still have to pay for whatever is left, travel, staying there for potentially several weeks to recover, and not being able to work now from pain, and after the surgery while I am recovering.

Endometriosis is a crippling disease that impacts 1 in 10 women, and often takes 5+ years to be diagnosed with. There is no cure for endometriosis, and the treatments are incredibly limited. The most effective treatment is excision surgery, which is why I desperately need your help to improve my quality of life, and help fight this disease.

Endometriosis is not a death sentence, but it is a life sentence. I appreciate everyone who takes the time to read this, share this, or just remember the impact these diseases can have on women. If you’re able to donate anything at all, it will be appreciated beyond words. This surgery could give me a chance to work again, have pain free time with friends and family, and give me back some quality of life.

Thank you all!

Rachel Warren

Hi, I'm Raina. I'm 34, and I have stage 4 endometriosis.

On June 20, I underwent excision surgery with Dr. Nicholas Kongoasa in Atlanta — one of the few specialists in the country truly trained to remove endometriosis at its root and promote integrative aftercare. After years of pain, confusion, and misdiagnosis, I am happy to have found a path forward — and I took it.

During surgery, Dr. Kongoasa discovered deep infiltrating endometriosis affecting my bowels, and had to remove my appendix, which had been compromised. The recovery hasn’t been easy, but the relief from relentless pain and the chance to feel at peace in my body again has made it more than worth it.

The surgery and recovery stay came to $8,500 out-of-pocket, plus $800 in hotel costs while healing far from home. I was able to secure 12-month interest-free financing, and while I’m deeply grateful for that, the monthly payments are still a challenge as I recover and try to rebuild my energy, strength, and financial stability.

Endo changed every part of my life — physically, emotionally, professionally. I used to be an avid dancer, a doctoral researcher, and someone who loved to move through the world with energy and purpose. Over time, that world shrank. Even walking became painful, and brain fog, digestive issues, and chronic fatigue became my normal.

I’ve done everything I could to manage naturally — from gut healing and bioidentical progesterone to clean nutrition, acupuncture, and integrative care — but it simply wasn’t enough anymore. I was having multiple large endometriomas over 10cm every few months, with intense bloating and pain.

To stay afloat, I took a remote job at lower pay so I could manage symptoms from home. I’ve missed dancing, time with family, and the career I once chased so hard. But I’ve also poured my experience into something meaningful: my page, @bloom.beyond.endo, where I share honestly about the journey — what helps, what doesn’t, and what I wish I knew sooner. That space has become a lifeline, not just for me, but for so many others navigating this invisible illness.

If you’ve made it this far, thank you. If you feel moved to contribute to my healing journey — even just a few dollars — it would mean the world. And if that’s not possible, sharing this page or sending prayers is just as impactful.

Your donation helps with:

- Monthly payments toward my $8,500 surgery bill

- Recovery expenses like supplements, acupuncture, and pelvic therapy

- Allowing me to keep creating free resources for the endo community

I’m hopeful that this is my turning point — toward more movement, more life, and hopefully, dancing again.

For those of you who might not know me, I'm Brittany. I'm reaching out to seek your support as I prepare for an essential endometriosis excision surgery—crucial for my health and well-being.

My journey with endometriosis has been incredibly challenging. As long as I can remember, my periods have been more than just inconvenient—they’ve been overwhelming. In my younger years, the pain was so intense that I often missed school. I would try to alleviate the agony by taking scalding hot baths, sometimes nearly passing out from the heat and pain combined. Crawling to my parents' room at night, I would find myself on my hands and knees, crying from the unbearable discomfort.

A vivid memory stays with me: at 11 years old, I was at a slumber party when I woke up in the dead of night, writhing in pain. Too nervous to wake my friend's mother, I turned to my friend, who offered me two Midol pills. Even though I hadn’t yet learned to swallow pills, desperation drove me to chew them. It was disgusting, but I didn’t care.

At 15, I visited an OBGYN, only to be reassured my symptoms were part of "adjusting to becoming a woman" and labeled as merely "painful periods." He suggested the pill for relief, never mentioning endometriosis. Grasping at any solution, I accepted the prescription. While the pill dulled the pain somewhat, allowing me to attend classes, it never fully resolved the issue. I completed nursing school and eventually decided to stop taking the pill to see if I could manage without it. However, the pain promptly returned. In my gut, I knew something was wrong, but that little voice in my head telling me it was all just a part of womanhood rang louder than my gut. I decided to tough it out as best I could.

I adjusted my life around the pain, developing coping mechanisms, rescheduling events, canceling plans, and relying on extra-strength Tylenol and Ibuprofen daily during my periods. Over time, the pain changed. Instead of debilitating cramps, I started experiencing intense aches and throbs in my lower back, extending down my legs and into my feet. This aching was so severe that I thought I had sciatica. I didn’t connect the dots, assuming it was just the physical toll of being a nurse. Now, I realize that cyclical extreme back and leg pain is a major red flag for endometriosis.

In my yearly physicals, red blood cells started showing up in my urine screenings without any signs of UTIs, and I noticed increased urinary frequency and burning. These symptoms are also indicative of endometriosis, something I wasn’t aware of then. My periods became shorter, consisting mostly of frequent clots. Again, now I know this is a sign of endometriosis.

Concerned about my shortened periods, I had my fertility tested at 31. The results showed my egg count was 0.7—equivalent to that of a 40-year-old. This alarming data point propelled me into researching endometriosis more deeply. I finally had evidence that something was wrong. However, when I went to see my OBGYN nurse practitioner, I was told my AMH level was just the “low end of normal” and not to worry. I was dumbfounded. The reference range for this value spans from 0.1 to 14, encompassing those in menopause to individuals with PCOS. How could this be considered normal for someone my age? I was furious, but I finally realized I was being gaslit, time and time again, by the medical professionals I trusted.

This compelled me to dive deeper into endometriosis research. I was determined to find answers and stop the cycle of misinformation. I discovered the unfortunate reality that women's health is severely underfunded and under-researched. I learned that standard OBGYNs often perform ablation surgery on women with endometriosis, instead of the gold standard excision surgery, which actually removes endometriosis lesions rather than simply burning the entire abdominal cavity. I learned that standard OBGYNs are not qualified to recognize and excise endometriosis lesions, despite the insurance companies stating they are.

After tirelessly searching for an endometriosis excision specialist, someone truly qualified to treat this condition, I found Dr. Behbehani. From our first meeting, she was a revelation. Dr. Behbehani was the first doctor to genuinely listen to my concerns. She spent almost an hour with me, allowing me to share my full history and experiences. Unlike others, she personally conducted my pelvic ultrasound, rather than delegating it to a technician.

Dr. Behbehani validated all of my concerns, including those about my AMH egg count and the constant pain I've been enduring. During the ultrasound, she discovered that my right ovary is twisted behind my uterus and has become scarred to my back abdominal wall. This upcoming surgery aims to remove all the endometriosis lesions and scar tissue in my abdominal cavity. It promises to liberate me from the relentless cyclical pain that consumes two weeks of every month. That's half of my life spent in discomfort and misery.

Moreover, this procedure holds the potential to reverse the ovarian damage I've suffered, giving me a real chance to have children naturally, without resorting to IVF. This surgery is truly my light at the end of a dark tunnel.

You might be thinking, “you’re a nurse, how could you miss this?” Well, unfortunately, in nursing school, little was taught about endometriosis—limited to symptoms like heavy bleeding, passing large clots, and debilitating pain that makes attending school or work impossible. Through my research, I have learned that endometriosis is so much more than that. It is a multifaceted, systemic inflammatory condition. Endometriosis is not something anyone should have to “just deal with.” It’s not just part of being a woman; it’s a serious condition demanding attention and understanding.

However, the financial burden is daunting. The cost is significant, and my insurance refuses to cover Dr. Behbehani's fee, instead suggesting I undergo the outdated and ineffective ablation surgery with a standard OBGYN. But I can't accept that. I deserve the proper medical care needed to tackle this disease head-on. In fact, every woman on this planet deserves the same.

Once I'm on the path to recovery, I am determined to advocate fiercely for women's health. But first, I need help from my community. In an act of vulnerability and desperation, I am reaching out to ask for assistance to cover the $9,000 out-of-pocket medical expenses. Your support would make all the difference in helping me receive the care I need, and in enabling me to stand up for others in similar situations.

Thank you for your time & consideration.

With love,

Brittany

Help Launch Endo Excision for All: Funding Hope for Endometriosis Patients

Hello, I'm Nicole Notar, and I've started a foundation called Endo Excision for All. While other foundations focus on research and advocacy, we're tackling the missing piece of the puzzle: actually helping women pay for excision surgeries.

Why We Need Your Help

Endometriosis affects millions of women worldwide, causing debilitating pain and significantly impacting quality of life. The gold standard treatment is excision surgery, but here's the problem:

1. Lack of specific insurance coding for excision surgery severely limits coverage and reimbursement, forcing patients to forego treatment or accumulate crippling medical debt.

2. Scarcity of skilled surgeons within insurance networks creates substantial barriers to access, leading to prolonged suffering and potential disease progression.

3. Exorbitant out-of-pocket costs render this essential treatment unattainable for many patients in dire need, perpetuating a cycle of chronic pain and diminished quality of life.

That's where Endo Excision for All comes in.

Our Goals

1. Direct Financial Support: The majority of funds raised will go directly to covering or contributing to the cost of excision surgeries and related expenses for those who can't afford them.

2. Advocacy: We're working to raise awareness about the importance of excision surgery over less effective treatments like ablation.

3. Policy Change: We're fighting for the creation of a specific insurance code for excision surgery to make it more accessible.

4. Education: We're committed to helping women understand their options and navigate the complex world of endometriosis treatment.

How Your Donation Helps

Your contribution will kickstart our efforts to make a real difference in women's lives. Here's how we'll use the funds:

- Directly assist women in accessing excision surgery

- Support our advocacy efforts for policy change

- Invest in fundraising initiatives to expand our reach and help more women

It's important to note that we are an all-volunteer organization, and no money is used to staff the nonprofit.

Join Our Mission

Every dollar brings us closer to our goal of making excision surgery accessible to all who need it. Your support can change lives, offering hope and relief to those suffering from endometriosis.

Thank you for considering our cause. Together, we can make a significant impact in the lives of women battling endometriosis.

My story is similar to a lot of women: Years of being medically gaslit and dismissed. I have unknowingly been battling Endometriosis since I was 11 years old. I had incredibly painful and heavy periods when I was younger and suffered from chronic fatigue. Like most young girls, I was eventually put on birth control and told it was normal.

After college, and several years in the food industry, I finally had a "big girl job" working a 9-5 and living on my own. My health began to decline, and I found myself going from doctor to doctor trying to figure out what was wrong. The medications piled up, and then so did the procedures. An angiogram in December 2015 and a spinal epidural in January 2016 had me $10k in debt instantly. Naturally, neither of these procedures provided any relief or any answers. I flew to Florida to a Spinal Institute where I got no answers. I went to the NJ Headache Institute, still no answers.

In 2020, I made the decision to stop taking birth control and was unpleasantly surprised by how horrific my periods became. I had several instances of pain so horrific, I was on the floor of a concert venue in the fetal position, blacking out from pain almost certain I would be leaving in an ambulance. This happened several other times, leaving me hesitant and concerned to attend events alone.

In October 2024, I suffered a ruptured ovarian cyst that required bouncing from hospital to hospital to get relief and answers yet again. I was forced to wait and monitor it. In January, it was determined that the cyst had not resolved itself after imaging and that it had doubled in size, and I would need surgery. At this point, every doctor had told me it wasn't Endometriosis.

In March 2025, I had laparoscopic surgery to remove the cyst, which turned out to be an Endometrioma. There were also adhesions found all throughout my abdomen. My gyno claimed to have removed "many" of them and hoped to have bought me several years of relief. Unfortunately, not being an Endometriosis excision specialist, I am not facing a second surgery only 5 months later. I have still not financially recovered from the first surgery and fear the costs of an Excision specialist, along with the cost of another surgery.

I currently work full-time and have a part-time job, but the bills are astronomical, along with the suggested therapies and functional health doctors who seem to be the only ones looking at the whole picture. Any help would greatly alleviate some of the financial burden and allow me to go into this second surgery with less anxiety about the aftermath.

After years of being dismissed by doctors, I was finally diagnosed with endometriosis at 27. My journey began at 14 with severe pain, and worsened through my 20s as I built my culinary career.

An ineffective "exploratory" ablation surgery in December only made matters worse and accomplished little. Now I've found hope with Dr. Colon, an endometriosis excision specialist who can properly treat my condition and preserve my fertility.

We need $6,000 upfront for his fees, with additional surgery costs reaching up to $14,500. This doesn't include travel to Atlanta, accommodations, or post-op care.

Your support will help cover these critical medical expenses and give me a chance at both pain relief and starting the family we dream of.

Thank you for helping me fight this battle against endometriosis.

With gratitude,

Maria

My name is Sabrina Ramirez; I’m 28 years old, a nurse, a wife, and a mom of two small kids, fortunately. Growing up, periods are not something that receives empathy. The pain and heaving bleeding are deemed to be normal. I vividly remember starting my first period at 11 years old in P.E. class after running. I was in excruciating pain, and the pain didn’t stop. The only relief I would get is balling up into the fetal position.

My mom did her best, creating an “emergency kit” of extra underwear, pads/ tampons, and Tylenol because of the numerous school calls telling her I once again bleed through my clothes. At the age of 16, I went on the birth control pill for my irregular periods and heavy bleeding, feeling some relief as my periods started to regulate. I was even able to come off of the birth control around the age of 20.

A couple of years later, I had my two children, Matthew (5) and Ellie (2). After these pregnancies, I decided to get the IUD, only to be met with 7-day long periods, irregularity, and numerous hemorrhagic cyst ruptures. After numerous ER and urgent care visits, worsening pelvic pain, and bleeding, I removed my IUD in November of 2024, only to have no resolution of these issues.

My gynecologist chalked it up to the IUD, then PCOS, and finally suspicion of endometriosis. After multiple ultrasounds “only showing functional cysts” and normal labs he agreed to do a diagnostic laparoscopy. At my pre-op appointment, he stated I should cancel as he was “not going to find anything” - clearly unknowledgeable about how endometriosis doesn’t typically appear on scans.

Enough was enough, and I gratefully met Dr. Behbehani. I am so thankful to her for validating my concerns and pain while educating me that my cyst is not just function, my left ovary is adhered to the back of my uterus, and endometriosis is indeed suspected.

In attempts to get the surgery covered, insurance was not willing as it is out-of-network, and my initial provider was unwilling to write a referral as he is not properly trained on endometriosis and doesn’t understand the severity. Here I am, almost a month later, calling my insurance every day to negotiate some type of coverage, but hopes are low as there is still no insurance code for deep infiltrating endometriosis excision surgery.

I pray for the day to get the surgery I undoubtedly deserve and for the day women no longer have to advocate tooth and nail just to cross their fingers for gold-standard medical care.