Steven Vasilev, M.D., Endometriosis Specialist, Integrative Gynecologic Oncology & Complex Pelvic Surgery, Minimally Invasive Robotic Surgeon
City: Santa Monica, CA, USA
Philosophy: I am affiliated with a facility that is capable of molecular translational science research and testing and am interested in the molecular and immunomodulatory aspects of endo, as I am with my cancer patients. There is clearly some overlap, and that is my area of focus. We have an ongoing tissue repository study involving cfDNA and miRNA for all my patients. We also have a robust genetics counseling and testing program.
Medication: During the perioperative period we use ERAS modified care, combined with integrative modalities such as acupuncture and acupressure, to allow faster recovery with lower narcotic use. Otherwise, to avoid opioid misadventures, I use pain management consultants to focus on that aspect of the case. Although I will prescribe NSAIDs or COX-2 inhibitors (assuming no pregnancy desire), these are usually part of the pain management consultant’s strategy. If there is concern about SIBO, will consider Xifaxan along with nutritional mods. I generally do not use hormonal manipulations of GnRH variants or Aygestin as these are handled by consulting REI or generalists that have referred the patient. However, where there is persistent severe pain or bleeding it is part of the multi-disciplinary discussion with consultants/referring docs. I often recommend over the counter seaweed as a lower intervention mainstay.
Approach to Persistent Pain: Both pre and post-operatively I liberally use and encourage pelvic floor therapy and pain specialist consultation and follow-up. I am also a board-certified integrative medicine practitioner and thus apply Eastern thought such as acupuncture and mind-body strategies as well as personal nutritional counseling and interventions. I do this with my endo as well as my cancer patients.