Dr. Chauncey Stokes, Gynecology & Minimal Invasive Surgery, Endometriosis Specialist.
City: Lansdowne, Virginia
Philosophy:
Please refer to the uploaded document for further discusion. I short I believe that endometriosis starts withearly development of the embryo. We can operate and remove endo but understanding the origin is still perplexing. WIth more genetic reseach we may have better answers to the question. For now extensive excision seems to afford best relief in the short term. Long-term relief usually requires more aggressive surgical intervention. For most patient they have had their children. For others they have been so debilitated by the disease that they opt for aggressive therapy at the exclusion of childbearing. Emotional/psychological support during the management of this disease is crucial to success because of its chronicity.
What type of surgery do you perform for endometriosis?:
Excision
Medication:
ORAL CONTRACEPTION , ANTIESTROGEN MEDS, ANTIDEPRESSANTS , GABPENTIN ,LYRICA I typically offer the younger females a trial of oral contraceptives followed by antiestrogen medication. I will add antidepressants and the neuro modulators as needed especially if the initial regimen is not sufficient. Counseling and relaxation techniques are considered as an adjuvant to the medical therapy just to get some relief
Approach to Persistent Pain After Surgery:
I initially use a questionnaire to help determine if patients have had sexual abuse and other psychological factors that may play in to the overall management. If they are positive in that regard I may refer out for further evaluation or before initiating medical treatment. I advise weight loss for those women with increased BMI. I try to avoid chronic pain clinics due to the concern about addiction. I have used them in the past when major meds for management have been unsuccessful. I have those who have used acupuncture but the results have been unpredictable. Exercise can be beneficial along with alterations in diet. I work with nutritionist to assist with developing anti inflammatory diets. The truth is that some of these patients are difficult to manage and we have little left once we have exhausted surgical and medical treatments. The initial questionnaires do help us to delineate those who may be difficult to treat. We try to set expectations and promote small successes as a step in the right direction steps