Laurence Orbuch, M.D., FABOG, Endometriosis Specialist, Gynecologist.
City: Los Angeles, California
Philosophy: I believe that the origins of endometriosis lie in the metaplasia theory, and can also be influenced by genetic predisposition and environmental factors and toxins which can promote its evolution. Endometriosis is also an inflammatory condition, with autoimmune elements as well, which predisposes these patients to sensitivity to other inflammatory triggers. It is therefore important to counsel these patients on how to improve their environment in regards to the foods they eat, products they use and habits which can better serve them. My approach to treating these individuals encompasses a holistic evaluation and streamlining of all aspects of their health and daily life.
What type of surgery do you perform for endometriosis?:
Excision
Medication: I utilize anti inflammatory medications such as Ibuprofen and Celebrex as well as neuro-modulators Pregabalin and Gabapentin. I also recommend compounded vaginal suppositories containing Valium, Baclofen and Lidocaine. In addition, some patients also benefit from trigger point nerve injections as well. The use of any and all medications is carefully tailored and managed by pain management physicians that I work closely with.
Approach to Persistent Pain After Surgery: Treatment of all co-existing pain generators must be a focused both pre and post surgery. Treating the chronic centralized pain, tight pelvic floor muscles, GI and Urologic issues, coexisting autoimmune and other conditions, nutrition, Mental Health conditions and counseling etc.