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[*] LIVE FROM MARYLAND PUBLIC TELEVISION, THIS IS "DIRECT CONNECTION" WITH JEFF SALKIN.

*] >> JEFF: GOOD EVENING AND WELCOME TO YOUR "DIRECT CONNECTION."

WE BEGIN OUR PROGRAM THIS WEEK ON LOCATION AT CAMDEN YARDS WHERE WE SPOKE EARLIER WITH ORIOLES OWNER DAVID RUBENSTEIN.

THANK YOU FOR TALKING WITH US.

TELL US THE STATE OF THE TEAM AS WE START THIS NEW SEASON?

>> I THINK THE TEAM IS IN PRETTY GOOD SHAPE.

HENDERSON WILL BE COMING BACK SHORTLY AND IS DOING WELL IN THE MINOR LEAGUES WHERE HE IS GETTING IN SHAPE.

WE HAVE PITCHING CHALLENGES BECAUSE AS YOU KNOW PITCHERS ARE ALWAYS HAVING ARM PROBLEMS BUT GENERALLY THE TEAM IS IN VERY GOOD SHAPE.

>> Jeff: THE PAYROLL IS WAY UP COMPARED TO RECENT YEARS.

HOW DO YOU SEE THAT NUMBER, HICH I'VE SEEN ESTIMATES 150 MILLION, 180 MILLION, COMPARED TO IS THERE A SWEET SPOT?

>> WELL, THE SPEIGHT SPOT IS WHATEVER IT TAKES TO WIN THE WORLD SERIES.

WE DON'T HAVE THE HIGHEST PAYROLL IN BASEBALL IT'S THE METS OR DODGERS WHICH IS 330 MILLION.

WE HAVE THE BIGGEST INCREASE PERCENTAGE WISE OF ANY TEAM.

WE WENT UP MORE THAN 50% FROM OUR PREVIOUS PAYROLL.

WE ARE OVER 160 SOME MILLION DOLLARS A BIG INCREASE FROM WHERE WE WERE.

>> Jeff: IS THERE ANYTHING ABOUT BASEBALL OR THE BUSINESS OF BASEBALL THAT YOU HAVE ELEARNED IN THE LAST YEAR?

IT WAS A YEAR AGO, THAT YOUR OWNERSHIP GROUP TOOK CONTROL?

>> I HAVE LEARNED A FEW THINGS.

I DIDN'T KNOW MUCH.

IT'S MUCH MORE INTENSIVE IN TERMS OF WHAT THE FANS THINK.

WHEN A COMPANY THAT CARLISLE OWNS THEY DON'T CALL ME EVERY HOUR AND SAY HOW IS IT GOING AND THEY DON'T ASK FOR AUTOGRAPHS.

HERE THE FAN EXPERIENCE OR THE INVESTOR EXPERIENCE IS MUCH DIFFERENT.

I'VE LEARNED ABOUT THE ECONOMICS OF BASEBALL.

A LOT ABOUT THE CHALLENGES OF BASEBALL.

AND SO I THINK I AM A BETTER OWNER THAN I WAS A YEAR AGO.

>> Jeff: A LOT OF CHALLENGES AND THIS IS WHAT THEY CALL A SMALL MARKET TEAM.

WHAT IS THE LONG-TERM PLAN?

AND THE LONG-TERM GOAL?

YOU MENTIONED WINNING A WORLD SERIES.

LONG TIME FAN.

I AM CONFLICTED ABOUT IT.

I'M JUST HAPPY THAT WE ARE NOT LOSING 100 GAMES A YEAR.

WORLD SERIES WOULD BE GREAT BUT A TEAM THAT IS COMPETITIVE ALL SUMMER IS AWESOME.

>> WE WANT TO HAVE A COMPETITIVE TEAM BUT WE DID WELL LAST YEAR AND BETTER THE PREVIOUS YEAR AND THIS YEAR I HOPE WE CAN PULL IT TOGETHER.

WE HAVE A GOOD TEAM WE BROUGHT IN A BUNCH OF PLAYERS THAT CAN ADD IN SPOTS WHERE WE NEEDED HELP.

AGAIN, BASEBALL NEEDS TO HAVE EQUILIBRIUM AND SMALL CITIES CAN WIN AS WELL AS BIG CITIES.

>> Jeff: WE HAVE ESTABLISHED THE PAYROLL OF UP AND THE PRICE OF HOT DOGS IS DOWN.

FAN FRIENDLY.

>> WE DECIDED TO HAVE A SPECIAL TYPE OF ARRANGEMENT.

YOU CAN GET A HOT DOG AND A DRINK AND THE DRINK NOW IS ONE WHERE YOU CAN GET FREE REFILLS.

YOU BUY A DRINK FOR $4 FOR A SODA, YOU CAN GET UNLIMITED REFILLS AND THE HOT DOG IS $5 NOW.

>> Jeff: WHEN YOU LOOK AT THE FANS, THE FANS IN THE SEATS, THE PEOPLE YOU WANT TO SEE THAT THE BALL PARK, WHAT'S THE PLAN TO CONTINUE TO GROW THAT?

>> WELL, WHAT WE'RE GOING TO DO IS REDO THE STADIUM A LITTLE BIT.

WE ENHANCED THE SOUND SYSTEM AND MOVED THE FENCE IN A BIT AND OTHER THINGS TO MAKE IT A BETTER FAN EXPERIENCE.

AT THE END OF THIS OFF SEASON COMING UP WE WILL DO A NEW SCOREBOARD AND CLUBHOUSE AND FAN EXPERIENCES.

WE ARE WORKING TOWARDS THAT.

WE WANT TO HAVE PEOPLE FEELS LIKE READINGS THIS IS THEIR TEAM AND THEY FEEL PRIDE IN BALTIMORE AND THE ORIOLES.

AND PEOPLE TELL THEIR FRIENDS AND RELATIVES COME TO A GAME IT IS A GREAT EXPERIENCE.

>> Jeff: YOU ARE GOING TO HAVE A BIG NEW SCOREBOARD.

THAT WILL BE OBVIOUS TO EVERYBODY.

ANYTHING ELSE ANY DRAMATIC RECONFIGURATION OF THE BALL PARK?

>> WE WILL HE ASHRINK THE BALL PARK A LITTLE BIT BECAUSE WE DON'T NEED AS LARGE A STADIUM AND FAN EXPERIENCE YOU CAN HAVE THE FOOD EXPERIENCES THAT YOU GET IN OTHER STADIUMS.

AND THE PLAYERS WILL LIKE IT MUCH MORE BECAUSE WE ARE GOING TO HAVE CLUBHOUSES ENHANCED SO MORE ENJOYABLE FOR THE PLAYERS BECAUSE OUR CLUBHOUSE IS MODEST COMPARED TO OTHER STADIUMS.

>> WHAT IS HAPPENING WITH BROADCASTING?

THE STORY OF THE MID-ATLANTIC SPORTS NETWORK YOU CAN WRITE A BOOK ABOUT THAT BUT THIS MAYBE THE LAST SEASON FOR THAT.

>> THERE WAS A SETTLEMENT AND IT RESULTED IN ALL THE LITIGATION GOING AWAY AFTER 20 YEARS OF LITIGATION.

AND THIS YEAR, THEY WILL BROADCAST THE ORIOLES GAMES AND THE NATIONALS GAMES AND IN THE SUBSEQUENT SEASON '26, THE NATIONALS CAN COME BACK TO THEM OR DO WHATEVER THEY WANT.

>> Jeff: IS THE OWNER HAVING FUN?

I SEE YOU TAKING SELFIES YOU CAN'T WALK THREE FEET EVERYBODY WANTS A SELFIE?

>> I THINK I'M HAVING FUN IN THE END I WANT TO MAKE SURE THE FANS ARE HAPPY NOT THAT I'M HAPPY.

I WANT THE FANS TO BE HAPPY AND HAVING A GOOD TEAM ON THE FIELD.

I THINK I'M PRETTY HAPPY.

BUT THAT IS HOW -- IT'S NOT ALWAYS DIFFICULT TO BE HAPPY.

HAPPINESS HOW YOU GET HAPPINESS IS COMPLICATED BUT I'M HAPPY RELATIVELY SPEAKING.

>> Jeff: DELIGHTED TO HEAR IT.

AND FANS WILL BE DELIGHTED THAT YOUR SIGNATURE HAT MAYBE THERE IS A STORY BEHIND THE HAT BUT IT'S FOR SALE NOW?

>> WHAT HAPPENED I WAS IN ZAIRE ASSOCIATED TA AND WENT TO THE ORIOLES STORE AND PICKED OUT THIS HAT.

IT WASN'T IN DEMAND FOR A WHILE AND IT'S FOR SALE HERE.

AND ALL OF A SUDDEN PEOPLE WANTED TO GET THE SAME HAT AND THERE'S DEMAND WE ARE PRODUCING IT NOW WE HAVE IT AT THE ORIOLES STADIUM NOW.

>> Jeff: YOU TWEETED A PICTURE OF YOURSELF AS A YOUNGSTER WITH YOUR LITTLE LEAGUE BASEBALL TEAM.

TELL US ABOUT YOUR BASKETBALL EXPERIENCE.

>> WE GREW UP NOT TOO FAR FROM EACH OTHER.

>> Jeff: COUPLE BLOCKS.

>> AND I PLAYED ON A LITTLE LEAGUE TEAM AND I WAS AN ALL-STAR SHORTSTOP.

I'M NOT SURE THAT THAT REALLY MEANT THAT MUCH.

THERE WEREN'T SANITY KOUFAXES IN THE LEAGUE.

BUT I DID OKAY AT AN 8, 9, 10-YEAR-OLD BUT I PEAKED AT 11 OR 12.

>> Jeff: WHAT CAUSED THE PEAK?

>> I DON'T KNOW ALL OF A SUDDEN MY FRIENDS WERE GETTING BIGGER AND I WASN'T GROWING THAT MUCH AND I THINK I WASN'T THAT GOOD AN ATHLETE TO BE HONEST.

>> Jeff: BASEBALL AS A SPORT, WHEN YOU THINK ABOUT PROFESSIONAL SPORTS IN AMERICA, THE NFL IS A JUGGERNAUT BIG FAN BASES FOR HOCKEY AND BASKETBALL AND COLLEGE BASKETBALL.

WHERE DOES BASEBALL FIT?

>> MORE PEOPLE GO TO MAJOR LEAGUE BASEBALL GAMES THAN NFL GAMES.

OBVIOUSLY WE HAVE A LOT MORE GAMES BUT IT DOESN'T MEAN PEOPLE ARE NOT INTERESTED IN BASEBALL BECAUSE THE TV RATINGS ARE NOT AS GOOD.

PEOPLE ARE INTERESTED AND IT IS A GREAT EXPERIENCE.

IT WAS OFTEN CALLED AMERICA'S PASTIME AND BASEBALL CONNECTS WITH FAMILIES THROUGH GENERATIONS.

PEOPLE LIKE TO GO TO GAMES AND SEE THEIR FRIENDS AND WATCH GREAT BASEBALL.

I THINK IT IS A DIFFERENT EXPERIENCE THAN THE NFL OR NBA THEY ARE GREAT LEAGUES BUT I THINK OUR LEAGUE HAS A LOT TO OFFER PEOPLE.

>> Jeff: POTENTIAL FOR LABOR ISSUE, LABOR DISRUPTION IN A COUPLE OF YEARS.

YOU CAN'T SPEAK FOR ALL THE OWNERS, FROM THE STANDPOINT OF YOUR OWNERSHIP TEAM WHAT WOULD YOU HOPE TO ACCOMPLISH IN THE NEXT CONTRACT?

>> WHAT I HOPE IS GET SOMETHING THAT EVERYBODY AGREES ON ON TIME AND ON SCHEDULE AND IT PRODUCES MORE EQUILIBRIUM FOR ALL THE TEAMS SO THAT WHAT PEOPLE WANT TO DO IN THE SMALL CITIES OR MID-SIZED CITIES THEY WANT TO THINK THEIR TEAM HAS A CHANCE OF WINNING THE WORLD SERIES EVERYBODY THINKS ANYBODY CAN WIN THE WORLD SERIES.

>> Jeff: WE HAVE VIEWERS FROM FAR WESTERN MARYLAND TO THE LOWER EASTERN SHORE NORTHERN VIRGINIA WHAT DO YOU WANT THEM TO KNOW ABOUT MAKING THE TRIP TO BALTIMORE?

>> YOU DON'T HAVE TO LIVE IN BALTIMORE TO BE A BALTIMORE ORIOLES FAN.

YOU CAN LIVE IN SUBURBS OR OTHER PARTS OF THE STATE OR WEST VIRGINIA, VIRGINIA, PENNSYLVANIA.

WE HAVE A LOT OF FANS THAT COME FROM MORE DISTANT AREAS FOR THE GAMES I AM AMAZED FROM YORK PENNSYLVANIA OR WEST VIRGINIA AND THEY DON'T MIND DRIVING AN HOUR-AND-A-HALF BECAUSE THEY LOVE THE ORIOLES EXPERIENCE.

>> Jeff: ANYTHING ELSE YOU WANT FANS TO KNOW BEFORE WE PLAY BALL?

>> WHAT I WANT FANS TO KNOW I'M GRATEFUL FOR THEIR SUPPORT AND I'M TRYING TO DO FORT D I CAN TO MAKE IT POSSIBLE FOR US TO WIN A WORLD SERIES BUT I CAN'T DO ALONE.

HAVING GOOD FANS AND CHEER THE PLAYERS ON WILL BE HELPFUL.

PLEASE COME, CHEER, BUY DRINKS AND HAVE A GOOD TIME AND BRING YOUR CHILDREN.

>> Jeff: DAVID RUBENSTEIN WITH HIS SIGNATURE HAT.

THANK YOU FOR JOINING US.

>> MY PLEASURE NICE TO TALK TO YOU.

>> Jeff: THE ORIOLES HAVE A NEW PRESIDENT OF BUSINESS OPERATIONS THE FIRST WOMAN IN THAT ROLE.

WE SPOKE WITH CATIE GRIGGS.

MS. GRIGGS THANK YOU FOR JOINING US FOR SPEAKING WITH US.

WHAT BROUGHT YOU TO BALTIMORE?

>> IT IS AN OPPORTUNITY TO BE PART OF AN ICONIC CLUB IN AN AMAZING MARKET AND I FEEL PRIVILEGED TO HAVE THE OPPORTUNITY TO BE HERE.

>> Jeff: YOU HAD A SIMILAR POSITION IN SEATTLE BEFORE.

>> I DID, THAT'S CORRECT.

IT'S WHEN I LOOK AT THEM THEY ARE TWO FANTASTIC FRANCHISE WALL STREET GREAT OWNERSHIPS AND FANTASTIC FANS.

WHENEVER YOU HAVE A NEW OWNERSHIP IT PRESENTS AN OPPORTUNITY TO THINK DIFFERENTLY HOW DO YOU CONTINUE TO GROW AND SERVE YOUR COMMUNITY MORE EFFECTIVELY AND THERE IS A SIDE BENEFIT GETTING CLOSER TO HOME.

>> Jeff: WHAT IS IN THE PORTFOLIO OF PRESIDENT OF BUSINESS OPERATIONS?

AND WHAT IS NOT IN IT?

STARTING PITCHING PROBABLY NOT IN IT.

>> STARTING PITCHING IS NOT IN IT AND THAT IS GOOD FOR EVERYONE INVOLVED.

THE EASIEST WAY IF IT INVOLVES THE PLAYERS AND THE ATHLETES OR OUR MINOR LEAGUE SYSTEM THAT IS THE BASEBALL OPERATIONS GROUP AND THEY DO AND AINCREDIBLE JOB SEEING CHAMPIONSHIP BASEBALL HERE AT CAMDEN YARDS.

EVERYTHING ELSE IS THE EXPERIENCE YOU ARE HAVING INSIDE THE BALL PARK ON GAME DAYS.

IT'S THE WAY WE ENGAGE WITH THE COMMUNITY.

OUR TELEVISION BROADCASTING WAYS FIVE HUNDREDS CAN ENGAGE WITH OUR TEAM HERE AND BEYOND.

>> Jeff: IF THERE IS A YOUNG WOMAN WATCHING THIS WHO MIGHT DREAM OF BEING THE FIRST FEMALE PRESIDENT OF SOMETHING, MAYBE SPORTS RELATED, MAYBE NOT.

ANY CAREER ADVICE?

>> IT'S FUNNY.

I GET ASKED THIS A LOT AND IT NEVER OCCURRED TO ME TO BE THE FIRST FEMALE PRESIDENT OF ANYTHING.

THERE ARE YOUNG WOMEN THINKING THAT WAY IT IS A BIG STEP FORWARD.

FROM MY STANDPOINT IT'S JUST ABOUT HAVE CONFIDENCE IN YOURSELF AND DON'T BE AFRAID TO TRY NEW THINGS.

I HAVE BEEN INCREDIBLY SUCCESSFUL IN MY CAREER LARGELY THANKS TO A GROUP OF MEN AND WOMEN WHO HAVE BEEN SUPPORTIVE AND IT ALLOWED ME TO TRY NEW THINGS.

SUCCEED MORE OFTEN THAN NOT BUT SOMETIMES FAIL AS WELL.

FOR ANYONE GET COMFORTABLE BEING UNCOMFORTABLE BUT HAVE CONFIDENCE IN YOURSELF.

>> Jeff: WHAT IS NEW FOR 2025?

>> 2025 IS AN EXCITING SEASON.

WE HAVE BEEN BUSY AT WORK MAKING SURE WE CAN MAKE CHANGES TO ENSURE THAT CAMDEN YARDS REMAINS A PLACE THAT EVERYONE IN OUR COMMUNITY FEELS WELCOME.

MY PERSONAL FAVORITE IS THE INTRODUCTION OF A NEW VALUE MENU, $4 OR LESS AND $5 BEERS, $5 RECOGNIZING THAT FANS WANT TO HAVE DIFFERENT EXPERIENCES WHETHER YOUR KIDS WANT HOT DOGS OR PEANUTS OR GROWN-UP AND WE WANT TO ENSURE THERE'S SOMETHING FOR YOU.

>> Jeff: LET'S START THERE.

FOR A FAMILY ESPECIALLY, COMING TO A BALL PARK, CAN BE A PRICEY THING.

ANY SPORT.

WHAT MADE THE ORIOLES DECIDE THAT NEEDED TO BE ADDRESSED?

>> LOOK, IF YOU DO THE RIGHT THINGS FOR YOUR FANS, IT'S THE RIGHT THING.

SO FOR US WHEN WE WERE LOOKING AT OPPORTUNITIES THIS YEAR JUST AS YOU MENTIONED WE RECOGNIZE THERE ARE FAMILIES FOR WHOM THAT IS A REAL CONCERN.

AS A RESULT WE WANTED TO ENSURE THAT THAT WAS NOT A LIMITING FACTOR FROM HELPING THEM TO COME OUT TO THE BALL PARK AND SUPPORT THE TEAM THEY LOVE.

IT WAS GOING AND LOOKING AND MAKING SURE WE HAVE THINGS FOR ALL FANS.

EXCITING LOCAL RESTAURANTS WE'VE GOT THAT.

BUT IF YOU GOT YOUNG KIDS AND THEY POPCORN, PEANUTS, HOT DOGS, SODA, WATER, WE WANTED TO MAKE SURE THAT PRICING WAS NOT A REASON FANS FELT THEY COULDN'T COME TO CAMDEN YARDS.

>> Jeff: IT'S IMPORTANT TO INVOLVE LOCAL ENTREPRENEURS, RESTAURANTS, FAMOUS FOOD ITEMS FROM AROUND THE REGION.

>> THAT'S EXACTLY RIGHT.

AGAIN, ONE OF THE THINGS THAT IS MAZING ABOUT BEING A BASEBALL TEAM WE HAVE 81 AND HOPEFULLY MORE TIMES THAT WE GET TO WELCOME OUR COMMUNITY IN AND PEOPLE WANT DIFFERENT THINGS AND THAT IS A GOOD THING IT IS NOT A BAD THINGS.

FOR US THE OPPORTUNITY IS TO FIGURE OUT HOW TO DELIVER AGAINST THAT POINT.

RANGING FROM A VALUE MENU A DOG AND PEANUTS UP TO SANDWICHES FROM AMAZING LOCAL PURVEYORS.

>> Jeff: HOW DO YOU THINK ABOUT EVENTS AND GIVEAWAYS?

I WILL SEE AND I WATCH MOST OF THE GAMES.

WATCH MOST OF THEM ON TV.

AND YOU WILL SEE A BIG WEEKEND SERIES, AND MAYBE SATURDAY THERE IS A GIVEAWAY.

A BOBBLE HEAD, IT IS A SHIRT OFF SOME KIND.

AND THE CROWD THE PLACE, YOU NEW YORK IS FULL.

YOU WILL HAVE A SELLOUT FOR THAT AND HALF FULL THE NEXT DAY.

HOW DO YOU THINK ABOUT FROM A BUSINESS STANDPOINT THE IMPORTANCE OF THOSE EVENTS?

>> HOPEFULLY WE ARE NOT GOING TO BE HALF SOLD OUT THE NEXT DAY.

WE HAVE AN INCREDIBLE TEAM WHETHER OR NOT THERE IS A GIVEAWAY THERE IS A GREAT REASON TO BE AT THE BALL PARK.

WE RECOGNIZE SOME OF OUR FANS MAY NOT HAVE BEEN HERE FOR A WHILE AND NOT KNOW THEY ARE FANS YET.

ANYTIME WE CAN FIND WAYS TO CREATE OPPORTUNITIES FOR FANS TO HAVE THE SPRNS AND HOPEFULLY WANT TO COME BACK TIME AND TIME AGAIN, THERE ARE DIFFERENT ENTRY POINTS.

YOU CAN GET A HOCKEY JERSEY WE CAN HELP YOU FALL IN LOVE WITH BASEBALL.

WE WANT TO MAKE SURE WE ARE THERE FOR YOU, TOO.

>> Jeff: WE ARE DOING A HOCKEY ORIOLES?

>> WE ARE.

>> Jeff: THAT IS GOING TO BE BIG.

>> FUN.

>> Jeff: HOW DO YOU THINK ABOUT THE SPLASH ZONES.

WHEN YOU WERE IN SEATTLE AND STARTED TO SEE THIS TEAM ON THE EAST COAST, THE ORIOLES HAIR HOSING DOWN FANS AOF A BIG HIT.

DID YOU SHAKE YOUR HEAD?

WHAT DID YOU MAKE OF THAT?

>> IT'S AUTHENTIC TO WHAT OUR PLAYERS WERE DOING AT THAT POINT IN TIME AND IT MADE SENSE FOR THE MARKET AND IT'S FUN.

FROM MY STANDPOINT WHEN I GOT HERE I HAD THE OPPORTUNITY TO SIT WITH MY FAMILY AND IT IS A BLAST.

A BLAST OF WATER IN THAT GAME IN PARTICULAR.

IT REALLY IS A LOT OF FUN.

THERE'S INCREDIBLE ENERGY.

IT'S GREAT FOR FAMILIES.

A GREAT WAY TO EXPERIENCE THE GAME AND HAVE A DIFFERENT EXPERIENCE.

>> Jeff: YOU MADE IT BIGGER.

TALK ABOUT THAT AND SOME OF THE OTHER CHANGES PEOPLE WILL SEE AT THE BALL PARK THIS SEASON AND BEYOND.

>> WE DID MAKE THE SPLASH BIGGER THAT WAS AN AREA SOLD OUT EVERY SINGLE NIGHT.

AND WE WANT TO MAKE IT ACCESSIBLE TO MORE PEOPLE.

IT'S FUN IT IS A DIFFERENT WAY TO SPEND A DAY AT THE BALL PARK PARTICULARLY ON THE WARM SUMMER DAYS.

AND WE WANTED TO ENSURE WE HAD THE ABILITY FOR FANS TO TAKE PART IN IT.

OTHER ADDITIONS IS IN FRONT OF OUR SECTION 78, 80 AND 82 WE HAVE A SPACE WHERE KIDS AND THEIR PARENTS CAN GET CLOSER TO THE FIELD AND HAVE A UNIQUE OPPORTUNITY TO SEE UP CLOSE AND PERSONAL WHAT IS HAPPENING OUT THERE AND CATCH HOME RUN BALLS HIT BY ORIOLES.

>> Jeff: LET'S HAVE A LOT OF THOSE.

THANK YOU SO MUCH.

>> THANK YOU SO MUCH FOR HAVING ME.

[*] >> Jeff: AND JOINING US TO TALK ABOUT YOUR HEALTH IS Dr. FARINAZ SEIFI, A MINIMALLY INVASIVE AGAIN CLOJIC SURGEON AND PROFESSOR AT THE UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE.

DOCTOR THANK YOU FOR JOINING US.

ONE OF THE CONDITIONS YOU FOCUS ON IS ENDOMETRIOSIS.

TELL US ABOUT THAT CONDITION.

>> THANK YOU SO MUCH FOR HAVING ME.

ENDOMETRIOSIS IS WHEN THE PLANNED OF THE UTERUS GOES OUTSIDE AND IMPLANTS IN THE PLACES THAT SHOULDN'T BE.

LIKE OVARY, BOWEL, OUTSIDE OF THE UTERUS IN THE CAVITY, IN THE FALLOPIAN TUBE AND CAUSE PAIN AND PAIN DURING INTERCOURSE, PAIN EVEN DURING BOWEL MOVEMENT, DIGESTIVE ISSUES AND INFERTILITY.

>> Jeff: HOW COMMON IS IT?

>> BEFORE WE WERE THINKING ABOUT 5 TO 10% OF THE WOMEN IN REPRODUCTIVE AGE.

NOW, ACTUALLY INCREASED TO 10-15%.

AND REPRODUCTIVE AGE AND UP TO THREE MILLION CASES PER YEAR WE DIAGNOSE IN THE UNITED STATES.

>> Jeff: YOU THINK THERE IS A REASON WHY THE CONDITION ITSELF IS BECOMING MORE COMMON OR IS IT BEING DIAGNOSED MORE OFTEN.

>> I THINK IT'S BEING DIAGNOSED MORE OFTEN.

IT IS ALEARNED INFORMATION AND MORE KNOWLEDGE THAT PATIENTS AND MEDICAL PROFESSIONALS GETS IS BECOMING MORE DIAGNOSED.

>> Jeff: YOU MENTIONED WOMEN OF REPRODUCTIVE AGE.

IN THAT LARGE WINDOW, WHERE DOES IT TEND TO COME UP?

AND DO WE KNOW ABOUT A CAUSE?

>> VERY GOOD QUESTION.

ENDOMETRIOSIS CAN COME AS EARLY AS ADOLESCENT'S AGE.

WHEN ADOLESCENTS' GET PUBERTY THE ENDOMETRIOSIS CAN COME.

IT CAN COME BETWEEN ANYWHERE BETWEEN AGE 15 TO 50.

THE YOUNGER, THE MORE RISK.

THE OLDER LESS RISK.

WHY THIS IS HAPPENING?

NOBODY KNOWS FOR SURE.

THERE ARE THEORIES THAT MAYBE RETROGRADE BLEEDING CAUSING THIS.

MAYBE GENETIC CAUSING THIS.

THEY ARE THEORIES ABOUT ENVIRONMENTAL EFFECT BUT NOTHING IS PROVEN.

AND RESEARCH IS IN PROGRESS.

>> Jeff: SO SOME WOMEN MAY BELIEVE MAY FEEL IT'S JUST A DIFFICULT PERIOD.

IS THAT SOMETHING YOU HEAR?

>> YES, DEFINITELY.

FIRST LET ME TELL YOU, A MESSAGE TO EVERY WOMAN IN THE REPRODUCTIVE AGE.

NO PERIOD SHOULD BE PAINFUL.

THAT'S NOT NORMAL.

THAT'S COMPLETELY ABNORMAL.

IF YOU HAVE PAINFUL PERIOD THERE IS A REASON FOR THAT.

NOT ALL THE PAINFUL PERIODS ARE ENDOMETRIOSIS.

AND NOT ALL OF THE ENDOMETRIOSIS IS CAUSED ONLY PAINFUL PERIOD.

SO WHEN YOU HAVE A PAINFUL PERIOD PLEASE SEEK MEDICAL ADVICE FROM YOUR OBGYN.

AND NOW -- GO AHEAD.

>> Jeff: NO, PLEASE.

>> NOW IF THE ENDOMETRIOSIS ONLY BAD PERIOD OR PELVIC PAIN DURING PERIOD, NO.

CAN CAUSE CHRONIC PELVIC PAIN, CAN CAUSE PAIN DURING INTERCOURSE, BLOATING, CONSTIPATION, DIARRHEA, NAUSEA, PAIN DURING VOIDING AND URINATION ALL COMES FROM ENDOMETRIOSIS.

>> Jeff: WE MENTIONED IN YOUR INTRODUCTION THAT YOU ARE A SURGEON.

IS THAT THE ONLY TREATMENT OR WHEN IS SURGERY INDICATED?

>> ENDOMETRIOSIS IS A MULTITREATMENT.

AND THE REASON WHY WE START FROM MEDICAL TREATMENT.

IF MEDICAL TREATMENT FAILS OR PATIENT IS SEEKING INFERTILITY AND THEIR ORGAN IS AFFECTED, BY THE ENDOMETRIOSIS LIKE BLOCKAGE OF THE FALLOPIAN TUBE, LARGE CYSTIC MASS THAT IS PREVENTING HER TO GET PREGNANT THEN WE GO TO THE SURGICAL MANAGEMENT.

SEVERE PAIN IS ANOTHER REASON THAT DOESN'T RESPOND WELL TO MEDICAL TREATMENT AND WE PROCEED WITH THE SURGICAL MANAGEMENT.

WE OFFER THE UNIVERSITY OF MARYLAND WE OFFER MINIMALLY INVASIVE PROCEDURES FOR ALL THE ENDOMETRIOSIS SURGERIES, INCLUDING WE PERFORM NEUROLIE SIS WHICH DECREASE THE PAIN SIGNIFICANTLY.

AND ONE MORE MESSAGE THAT ENDOMETRIOSIS SURGERY SHOULD BE DONE BY A ENDOMETRIOSIS EXPERT.

>> Jeff: AND WHY IS THAT?

ONE OF THOSE THINGS WHERE SOMEBODY WHO DOES IT TWICE A YEAR MAY NOT BE AS SPEEDY OR MAMIES THINGS THAT SOMEBODY THAT DOES IT EVERY WEEK WOULD CATCH?

>> SO IF THE ENDOMETRIOSIS SURGERY NOT DONE WELL AT THE FIRST ATTEMPT, IT WILL INCREASE THE RISK OF FUTURE FERTILITY SURGERIES.

IT MEANS THAT IF WE FAIL TO REMOVE ALL THE CYSTIC MASS OF THE ENDOMETRIOSIS IN THE FIRST ATTEMPT, WE SHOULD GO BACK IN TWO MONTHS AND THREE MONTHS AND REMOVE THE OTHER PART OF IT.

AND THAT DAMAGE [INAUDIBLE] THAT ACTUALLY PUT MORE HARM TO FERTILITY THAN [INAUDIBLE] >> Jeff: I'VE READ THAT HYSTERECTOMY IS SOMETIMES INDICATED.

WHEN IS IT NECESSARY?

AND FOR PEOPLE WHO ARE WOULD LIKE TO STILL BE FERTILE CAN THAT BE PUT OFF?

>> DEFINITELY.

HYSTERECTOMY IS THE LAST RESORT.

AND NOBODY CAN GUARANTEE THAT EVEN WITH HYSTERECTOMY WE CAN TREAT THE ENDOMETRIOSIS.

SO PLEASE, PLEASE, SAY NO TO HYSTERECTOMY.

THERE ARE MORE, AND MORE OPTIONS EVEN SURGICAL OPTIONS OTHER THAN MEDICAL OPTIONS TO REMOVE THE ENDOMETRIOSIS TO ABLAT THEM WITH THE LASER ORGAN SURGICALLY, AND TO EXCISE ALL OF THE ENDOMETRIOSIS NODULE TO RELEASE THE NERVE THAT IS AFFECTED BY ENDOMETRIOSIS.

AND THERE IS NO WAY THAT WE CAN GUARANTEE THAT HYSTERECTOMY WILL SOLVE YOUR PROBLEM.

JUST KEEP IT AS A LAST RESORT.

>> Jeff: ARE THERE DEGREES OF THE CONDITION, MILD, MODERATE, SEVERE?

AND IF THERE IS SUCH A THING FOR SOMEBODY WITH MILD ENDOMETRIOSIS, WOULD IT TEND TO PROGRESS OVER TIME?

>> THERE ARE STAGING FOR ENDOMETRIOSIS.

AND THAT DEPENDS ON HOW MANY NODULES, WHAT IS THE SIZE OF ENDOMETRIOSIS NODULES AND WHERE IS THE ENDOMETRIOSIS, THE DEGREE IS DIFFERENT.

IT DOESN'T MATTER WHAT DEGREE YOU HAVE THAT MATTERS FOR US AS A SURGEON TO COMPARE IT FOR THE NEXT.

A PATIENT CAN HAVE SEVERE PAIN AND A PATIENT WITH SEVERE ENDOMETRIOSIS CAN HAVE MILD PAIN.

MILD ENDOMETRIOSIS CAN PROGRESS TO SEVERE ENDOMETRIOSIS.

SO THE EARLY DIAGNOSIS AND EARLY TREATMENT IS ESSENTIAL.

>> Jeff: WE ARE TALKING ABOUT MINIMALLY INVASIVE PROCEDURES THAT OBVIOUSLY MEANS NO BIG INCISION.

WHAT IS THE ADVANTAGE TO THE PATIENT?

I'M IMAGINING LESS PAIN, MAYBE SHORTER TIME IN THE HOSPITAL?

>> SO, MINIMALLY INVASIVE PROCEDURE ACTUALLY WE COMBINING WITH THE ENHANCED RECOVERY AFTER SURGERY.

MEANS THAT PATIENT CAN DRINK UP TO TWO HOURS BEFORE COMING TO HOSPITAL.

AFTER THE SURGERY, EVEN AFTER HYSTERECTOMY WITH THE MINIMALLY INVASIVE PROCEDURE THEY CAN GO HOME THE SAME DAY.

THEY CAN REST IN THEIR OWN BED WITH THEIR OWN FAMILY.

AND HAVE A COMFORT OF THEIR OWN HOME.

THEY RETURN TO WORK IS SIGNIFICANTLY SHORTER THAN OPEN PROCEDURES AND MORE TRADITIONAL PROCEDURE.

OTHER THAN MOST OF OUR PATIENT DOESN'T NEED NARCOTIC MEDICATION.

THEY DON'T EVEN USE OXYCODONES THAT WE GIVE PATIENTS THEY DON'T USE.

>> STARTING POINT FOR A YOUNG WOMAN WHO HAS SYMPTOMS YOU DESCRIBED WOULD BE YOUR LOCAL OBGYN IF YOU HAVE SUCH A RELATIONSHIP?

>> YES, DEFINITELY.

ANY ABNORMAL MENSTRUATION, ANY ABNORMAL PAIN YOU HAVE, PLEASE DESCRIBE IT TO YOUR OBGYN.

ALL THE PAIN SHOULD BE HEARD BY US.

AND THEN IF THERE IS A SUSPICION FOR ENDOMETRIOSIS, PLEASE ASK FOR REFERRAL FOR THE ENDOMETRIOSIS EXPERTS.

>> Jeff: AND WHAT DO YOU THINK IS NEXT?

TERMS OF FRONTIERS IN MEDICINE WHAT DO YOU THINK IS ON THE HORIZON?

>> THERE ARE GOOD ADVANCED RESEARCH ON THE LEVEL OF GENE AND ALSO AT THE LEVEL OF DIAGNOSIS OF ENDOMETRIOSIS.

BY BLOOD TESTS, BY SALIVA TESTS AND SO THAT WILL ACTUALLY HELP US TO DIAGNOSE ENDOMETRIOSIS AS SOON AS POSSIBLE.

>> Jeff: OUR THANKS TO Dr. FARINAZ SEIFI OF THE UNIVERSITY OF MARYLAND MEDICAL CENTER AND THAT IS "DIRECT CONNECTION" FOR THIS WEEK.

BACK FRIDAY WITH "STATE CIRCLE".

AND THE LATEST ON MARYLAND POLITICS.

JOIN US FRIDAY EVENING AT 7:00 P.M. NOW FOR ALL OF US AT MPT, THANK YOU FOR WATCHING AND HAVE A GOOD NIGHT.