Taking Charge of Your Health

(uplifting music) – Welcome back to the
Pelvic Health Summit. I’m here with Dr. Iris Kerin Orbuch. She is a board certified
OB-GYN, and the director of The Advanced Gynecological
Laparoscopy Center in both New York and Los Angeles. She specializes in pelvic
pain and endometriosis, and she has a bi-coastal practice. Thank you so much for being here. – [Dr. Iris] Thank you you for having me. – So tell us a little bit about your practice and approach. – Sure. So I’m fellowship trained in
minimally invasive surgery, with a focus on endometriosis treatment, and the surgical treatment
for endometriosis is excision of endometriosis. That means in a minimally invasive fashion or laparoscopy or robotically excising or removing the endometriosis, but what I’ve learned
is that endometriosis affects so much more, meaning typically when a
woman has endometriosis, we need to address her from
the mind down to her toes, and most women with endometriosis have multiple other reasons
for having pelvic pain, many of whom have pelvic
floor dysfunction, meaning tight muscles. Many have interstitial cystitis, and many have an upregulated
central nervous system, known as central sensitization, so it’s my job, when a
woman comes into my office, to listen to them, to listen
to all of their syptoms, all of their complaints, to try and identify the multiple
reasons why they have pain, and then to create a treatment plan addressing each one of
their coexisting conditions. Typically, the mainstay of what I do is surgical excision of endometriosis, excision being the
particular type of surgery that’s required when a
woman has endometriosis, but I do so much more, and I don’t jump to surgery. That’s part of the treatment plan, but it’s addressing the
mind down to the toes, typically from an East meets West approach is how I address my patients. – Fabulous. I love that East meets West approach. Can you tell us a little bit more about that in detail, how you incorporate mind and body, in your practice? – Sure. Well, when a woman comes into my office, the first thing I actually do is I listen to them, and I can learn a lot by the
way she’s describing her pain. Can she sit in the chair
for the hour and a half that we’re talking? Does it hurt for her to sit in the chair? Does she need to keep getting up in order to alleviate pain from sitting? Is she getting up to
urinate multiple times during our lengthy consultation? Does she describe external
influences in her life that perhaps worsen her pain, maybe a high pressure job, or a difficult social life, and I typically always
start with nutrition, and I’m a big proponent,
I’m a health junkie myself, but I’m a big proponent of
an anti-inflammatory diet, organic foods, because
pro-inflammatory foods tend to aggravate inflammatory conditions, endometriosis being an
inflammatory condition, so I think eating right, I counsel women, and I
go into much more depth about how you eat correctly. I think adopting a lifestyle
where it allows you to begin your day, whether
it’s with mindfulness or meditation or doing yoga, whether it’s going for a walk, whether it’s cooking, whatever it is that relaxes and calms you, even if it’s 10 minutes a day, I think it’s very important when a woman has pain, and typically, endometriosis
is one of the reasons, I know in the summit, you’re talking about a
lot of different reasons why a woman and a man has pain, but all of those can upregulate
a central nervous system, so the more we can kind of
quiet a central nervous system, the better we’re gonna be able to take care of one’s pain. So I’m always, like I said, starting with diet/nutrition, incorporating a lifestyle that’s healthy, incorporating exercise. It doesn’t have to be crazy exercise. If someone likes to go
for walks, that’s fine. If someone is big into yoga, that’s fine. Whatever. I try and modify based on an individual, what an individual likes. I think there’s definitely
a role for acupuncture, or massage or just whatever one likes that can help relax them. So those are pretty basic steps that are without any
risk or without any harm, meaning the benefit is
outweighing any risk, and then there’s a lot of, depending on what reasons a woman has, why a woman has pain, then I will adopt and
prescribe, essentially, other ideas or other approaches to help them with their pain. Now it doesn’t mean we don’t
use a Western approach. I will start with an Eastern approach, and will combine it together
with a Western approach. – Definitely, and one of the things I’ve been really learning from the summit and now from you, as well, is that it is so important
to take care of yourself, not just the center of where it hurts, but yourself as a whole body, and whole being, and definitely diet, and we’ve been interviewing
a bunch of other, more mind/body focused people, and so it’s really nice to know that someone with your incredible bio and credentials is
incorporating those things into your practice, as well. So let’s get into a little bit of the treatment side of things. Can you walk us through some
of the different treatments that you offer, and what an
experience could be like, coming into your practice for treatment? – Sure. So I assume we’re talking about
a woman with endometriosis. But typically a woman
comes into my office, and is describing a whole host of symptoms that 100% of those symptoms actually may be because of endometriosis, or maybe only a quarter of the symptoms are due to endometriosis, and the other three quarters could be due to other coexisting conditions, so I always ask for the
medication records in advance, and I try and read women’s
imaging, ultrasounds, if they’ve had any CT scans, any emergency room visits, any prior operative reports, pathology reports, anything. I just try and read anything
that is given to me, any lab work, and then when
a woman walks into my office, I just tell them, just I can imagine why you’re here, but in your own words,
where did this all start? Because it’s important for me to know if they’re 36, and they’re saying, “Oh my gosh, since the
first month I got my period, “when I was 12, “I had debilitating pain, “and I went to the nurse’s office,” right? So that means if they’re coming to me, let’s say, at age 36, and they’re starting at 12, it’s over 20 years of symptoms, as opposed to a woman
who’s coming in at 36, and said, “Wow, I have
been perfectly fine, “and for the last two years,” so that’s a whole
different set of symptoms that a woman’s having, and a different timeline, so I really listen to a woman. I identify all the different
reasons why they have symptoms. Typically, most women with endometriosis will present with intestinal
symptoms initially, meaning they’ll have
constipation, or bloating, or diarrhea, or painful bowel movements, and just from the straining on the toilet, and the straining from the constipation, they’ll have pelvic floor tight muscles, so typically, the first stop, in addition to eating
right and mindfulness, I’ll send them to a pelvic
floor physical therapist, to address their tight muscles, because the tight muscles
in and of themselves can be up regulating a woman’s
central nervous system, and causing a whole host of symptoms, in addition to their
endometriosis symptoms. So I have to listen, figure out what kind of
symptoms they’re having, where are they coming from, and then create a treatment plan based on those. But typically, most women do have pelvic floor tight muscles. I’ll send them for PT, and then if they have endometriosis, and they need a good surgery, typically, in an ideal setting, a woman has done a lot of research, and they haven’t had any surgery, which is fantastic. Unfortunately, most of the time, a woman has had one, two,
four, five, eight or 10 laparoscopies that perhaps
were not done properly, where there was burning
or laser or ablation or cautery, and the
endometriosis implant was burnt, rather than removed, and then that causes more
scarring, more problems, so I really have to go
back and explain to, and really lay the groundwork, so a woman can build upon an understand why is this surgery gonna be different? And what did all of those
surgical interventions do their central nervous system? How did it upregulate their
central nervous system? So we have identify every
reason a woman has pain, and then create a treatment
plan for every reason, and then, typically, if they have not had a good surgery, or they haven’t had a proper surgery, an excision of endometriosis done in minimally invasive fashion is typically something that I recommend, but I never start with that. I start with all those other things. I try and get them into
PT for at least six or eight or 10 sessions, or I try to get them into mindfulness. I try and get them to start eating right. I try and get them to
change their lifestyle, because that will make a big difference. Once I give them a good surgery, then they continue down the path of a healthy lifestyle, ’cause they, each woman needs to identify, they’re coming in with a
whole host of symptoms, but if they think my surgery’s gonna fix their tight muscles, it’s not going to. My surgery’s gonna fix the endometriosis that thereby caused, perhaps, the constipation and the
straining on the toilet, but the tight muscles that a
result of the endometriosis need to be fixed by pelvic
floor physical therapy. So I spend a lot of time educating, and starting a patient
with non-surgical options, as we lead up to surgery. It’s not instead of, it’s in addition to, to enhance the surgical outcome. – Definitely. And for those who don’t have the pleasure of working with you as their surgeon, what are some important questions to ask a surgeon who is about to perform a laparoscopy? – So you really want each woman to do a lot, a lot of research, because there’s just a handful of endometriosis excision
surgeons across the country because even in my residency, I was not trained to do
endometriosis excision. I only learned that,
actually, in my fellowship, and endometriosis also has a lot of different visual appearances at the time of laparoscopy. Honestly, none of which that I was taught during my four years of residency, all of which I was taught
only in my advanced fellowship on minimally invasive surgery, so because endometriosis can
have variable appearances. In residency, I learned
about powder burn lesions. That’s what I knew, Chocolate cysts, those two appearances, in but in actuality, endometriosis can appear
as clear vesicles, particularly in adolescents and teens. It can be red, it can be white, it can be brown, it can be fibrotic, which is engulfed in a lot of scarring. It can be these perineal windows, meaning you have to be able to A, identify the endometriosis, and then B, be able to treat it properly, which is through excision
of endometriosis. So what I would encourage
women to ask their doctors is how many, well, one,
do you do excision, okay, of endometriosis? And a woman has to then take
the question a step further because lots of doctors will
say, yes, I do excision, when all they do is one
excision, all biopsy. So they’re removing
one lesion by excision. It’s a millimeter or two, just to have the pathological
report say endometriosis, but the rest of the endometriosis, they burn or laser or cauterize. So they have to really try and figure out the physician’s aptitude for
excision of endometriosis. If someone’s doing 200 deliveries a year, there’s no way that they can focus on endometriosis excision. I don’t deliver babies. I don’t, God bless a general OB-GYN. You know, their breadth of
knowledge is like this, right? So they know how to deal
with menopausal health, and health, and they know
how to do a C-section, a vaginal delivery. They know how to deal with nipple masses, breast masses, warts, abnormal pap smears, but their depth of
knowledge can’t be too deep, because their breadth is so wide. I have a very narrow focus, so I can know a lot about one subject. God bless a generalist. So you really need to
really ask the OB-GYN, is this your specialty? How much do you do? What are you gonna do if you find that the endometriosis
is stuck to my bowel? Because often, the endo
is stuck to the bowel. You don’t want a doctor saying, well, then I’ll close you up and send you to someone else. You want that doctor to do, at the same surgical setting, A, a diagnosis of endometriosis, and B, an excision of endometriosis. So you need an all in one. So you probably have to
do a lot of searching to find that doctor. – So definitely finding a
specialist is important, like yourself. Can you recommend any resources for people who are maybe in the Midwest, maybe in other countries, online resources to
find those specialists? – Yeah. There’s two great resources. One is, well, actually there’s two. So one is Nancy’s Nook. It’s a Facebook group that will only allow you
if you have endometriosis, and it’s a great resource. Say, let’s say you live in Arkansas. I live in Little Rock, Arkansas. I’m looking for a good pelvic
floor physical therapist, and I need to have surgery
by a good excision surgeon. Can someone recommend somebody? So that’s one. And Endo Warriors is another. Those are two really credible groups with great information, great admins, who are very passionate
about what they do, and they’re just there to
help facilitate learning and education because the
problem with endometriosis is that we as a group of gynecologists, we’re not being taught
properly in residency about endometriosis, so if the doctors, the generalists, are not being taught properly, they can’t educate
their patients properly, so the onus, unfortunately,
is actually on the patients, because our American College
has not updated our guidelines in way too many years, and so you really do have
to learn all you can learn and educate yourself about endometriosis. – Definitely. Thank you for that. We’ll link both of those
resources in the group, and now going into surgery itself, would you mind walking
us a little bit into what the preparation is like? We know, working with a pelvic floor PT, getting lifestyle/diet set up. What is the actual few
days leading up look like, and then the actual surgery, and then some, we can go
into recovery, as well. – Typically, what I try and do, like let’s say that patient
who I was talking about who has tight muscles and
she has endometriosis, I try and have her start the PT, like I had said before, so she can start identifying,
oh, wait a minute. This particular pain is getting better, after I go to physical therapy, and that pain is getting
better after physical therapy, but this other pain hasn’t changed at all, so it’s starting to help a woman sort of filter her different pains to recognize that they’re
coming from different places. So that’s important, going into surgery, and then we do a lot of talking. What if I find this? What do you want me to do? What if I find that? What do you want me to
do intraoperatively, but I do minimally invasive surgery. I specialize in laparoscopy
and robotic surgery. I love robotics for endometriosis, just because the camera is
a 3D high definition camera and the instrumentation has wrists just like my own natural wrist, and I find I can access the endometriosis much more efficiently from
a robotic perspective, but they’re little incisions. They’re closed with medical Crazy Glue. You go home that day, typically, but the surgery could
be on the shorter side. I never rush. I don’t even wear a watch when I operate, but it could be shorter, or it could be longer. There’s no correlation between
quantity of endometriosis and severity of disease, meaning someone could have a
belly fully of endometriosis, and be practically almost asymptomatic, or that same person, who has a belly full of endo can have debilitating pain, and the converse is true, as well. Someone could have two spots of endo, and have debilitating pain, or someone could have two spots of endo, and have no pain. So we can’t just go by someone’s pain and know what their abdomen
or pelvis will look like. My physical exam really helps me to have a good sense
of what I’m gonna find at the time of surgery, and yeah, I excise all the specimens. My whole goal is to try and make sure the benefits outweigh the risks, and to make sure I’m
restoring normal anatomy. Because what happens, the endometriosis starts
to stick to the bowel and the bladder and the ovaries, the Fallopian tubes, and then it pulls on the
pelvic floor muscles, and alters the nerves. So I’m trying to excise the endometriosis to restore normal anatomy. – Definitely. And what is the, I know that many women have to
go through multiple surgeries throughout their lifetime. Is there any sort of trend, in terms of space in between surgery, is it a feeling that a woman has? What does the follow up look like? – So I think the most important is your first surgery done right by an excision surgeon. My reoperation rate is less than five percent on my patients. So it’s very, but I get many patients who’ve already had two, four, five, eight, 10 surgeries before they’ve gotten to me, because they’re having tons of burning and laser ablation, which is A, not treating the endo, and B, causing worse problems because it’s causing more scarring and more adhesions. So my advice is teens get endometriosis. We know that endometriosis has been found in fetal tissue, so a young girl who’s 12 or 13 or 15, who’s having debilitating pain
going to the nurse’s office, and if birth control is
not covering her pain, we shouldn’t say, “Oh, wait til you’re 25 before
you have your first surgery.” No, because then a young girl who’s 12 to wait until 25, that’s 13 years of pain, right? 13 years of endometriosis growth. So we really have to
individualize our treatment, and my best advice is, and this is part of the Cochrane Review, which looks at all databases to find the best medicine, and when they talk about
ovarian cysts and endometriomas, meaning endometriosis
cysts on the ovaries, the first surgery done
right is the best approach, and the same thing. If you’re a teenager, and you’re having debilitating pain, birth control pills and
non-steroid anti-inflammatories are not helping, you need to have a good excision surgery. That’s what you need. I never tell patients, okay, I’ll see you back in two years for your next surgery. Not at all. It’s rare, and typically the patients
who I do reoperate on are patients who we were able to excise a lot of their endo,
but there’s a few spots that if I did excise them, I may have compromised fertility, and if their desire is their fertility, we’re gonna leave them in those spots, let them, God willing, achieve pregnancy, and then after they’re
done with childbearing, if they still, let’s say are
symptomatic from those areas, then we do something more definitive. That’s a lot of my reoperation patients. – That’s great to know that you’re taking the patients’ goals into consideration, and we did touch on a few myths, one being that you must
have many surgeries, so can you talk a little
bit more about other myths that are very common? – Yes. So big, big, big myth is that the way that we treat endometriosis is a hysterectomy and castration. Huge myth. That’s what I learned in
medical school, in residency. That’s what was taught to me, and it’s still being taught today. Now, if you take what’s the
definition of endometriosis, okay, the definitely
is when you have cells that are similar to the
cells in the uterine lining or similar to the endometrium, but they’re find external
or outside the uterus, that’s what endometriosis is. So why in the world would
removing someone’s uterus treat these cells that are found external to the uterus? So that’s a huge myth. There’s so many women across the country who have terrible endometriosis, but what’s happening is their doctors are not going in and
excising the endometriosis. They’re leaving all the endometriosis, and then they’re removing their uterus, meaning their reproductive organs. Then those women are actually in worse pain post surgery than
they were going into surgery so that is a huge myth, and another myth, we don’t
remove a woman’s ovaries or castrate them to treat endometriosis. So those two myths are just propagated through so much media, but they are not true. – Definitely. Thank you for addressing those, and we mentioned fertility. Can you talk a little bit about, for those out there with endometriosis who have, who are trying to conceive, or are trying to conceive again, can you talk a little bit about what you would tell those patients? – Sure. So firstly, I always tell patients, until you start trying, you don’t know whether you
have infertility or not. So just because you have endometriosis, it doesn’t mean that you’re
not gonna be able to have kids, but what I do tell my patients, if I’m diagnosing a
woman at 22, let’s say, I’m gonna tell her that yes, we do know that endometriosis
can impact fertility, so don’t wait until
you’re 35 to start trying, or think about freezing your eggs, if you’re not in the right
situation to have a child. You don’t, the treatment of endometriosis is not pregnancy. Pregnancy doesn’t make endo better, so I’m not telling someone to get pregnant whom it’s not the right time, or they’re not in a relationship, or they don’t have the ability
to take care of a baby. That’s not what I’m saying at all. If you are in a relationship, and you are thinking that
I’m thinking in five years, I wanna have a kid, you may wanna accelerate that process, or think about freezing your eggs, if you have the financial
ability to do so. So I just let patients know that we know that endo
can decrease fertility, and to sort of kind of
maybe think about your plans a little differently, because we know if you take all women who don’t have endo, fertility decreases at 35, so we don’t wanna have the
natural decrease in fertility coupled with the endometriosis
issues with fertility, and decreasing ovarian reserve. So I just think knowledge is power. – Definitely, definitely. Where are some credible resources where women who maybe are younger, maybe are older, who have endometriosis and who are looking for specialists who can help them plan
their fertility journey, understanding endo, are there any resources for people to look into practitioners? – Right, so most, so I’m based in Los Angeles and New York. I have reproductive endocrinologists who do free egg freezing seminars, usually once a month. So a woman can go and just
learn about egg freezing, what does it entail? They usually have free evening lectures, but I think it’s important not to just choose any
reproductive endocrinologist. You really need to choose one who understands endometriosis, because a lot of
reproductive endocrinologists will use a one size fits all, to help stimulate their patients, and ones who understand endometriosis and how endometriosis is inflammatory, and how it behaves tend
to have more success, so you know, I can guide
people to those patients, at least in New York or in Los Angeles, and those would be great questions to ask on Endo Warriors and Nancy’s Nook. Say, hey, I live in, I think we were talking about
Little Rock, Arkansas before. I’m looking for a
reproductive endocrinologist. Has anyone had luck with one who understands endometriosis? So you have to know that, as
a woman with endometriosis, you shouldn’t feel isolated or alone, because endometriosis affects at least 10% of the
population, probably 12. It’s close to probably about
180 million women worldwide, so there’s many women who
you should ask questions to, and query, and maybe learn
something from their path. They may be able to fast track you to get the right answers, based on where your
geographical location is. – Definitely. And again, we’ll put those in there, and also in our Facebook group, The Pelvic Health Support
Group on Facebook, there are a lot of people out there, so just for everyone watching, engage and ask questions, and everyone introduced
themself on a thread, so you can probably go and look and see if someone’s
in your city, as well. Let’s talk about some
other treatment options outside of surgery. I know that there are some pharmaceuticals that people take, some new things coming out. Tell us your experience with those. – Sure. You know, so I wish there was a magic pill that a woman with endometriosis could take that’s gonna melt their endometriosis. It’s not true, unfortunately, and for many women, endometriosis is genetic, meaning their mom has it, their aunt has it, their grandmother had it, has it, they themselves have a sevenfold higher likelihood of having it, so if a mom has it, then the daughter has a
sevenfold higher likelihood of having it, so you can’t take an anti-inflammatory, or a Motrin or an Aleve, and it’s gonna melt the endo. It may make the cramps
a little bit better, so you always wanna start
with the anti-inflammatories, maybe try a birth control pill or two. I wouldn’t start trying seven or eight or 15 birth control pills, which is what a lot of
patients who come to my office have been put on by their gynecologist. You know, try one or two, and try a continuous birth control pill. After a few months, when you feel that you’re tolerating that particular birth control pill. If that’s not working, go to the next step. Now, there are medicines and I have to be honest, I’m not big fans of them, because their side effect profile outweighs the benefit, and I’ll be honest. I have two daughters. I wouldn’t give my daughters any of the hormonal medicine. I’d give them birth control pills, I would give them anti-inflammatory pills, but I wouldn’t give my own kids, or even my worst enemy a medicine that’s gonna cause hot flashes and weight gain and memory loss, and osteopenia or weakened bones for someone to be on for three months, six months or a year, and then you go off of those medicines, and you still have those side effects, and now you’re right back where you were before you even began those medicines, so I think the pharmaceutical
industry has a, they’re trying to find their niche, but I don’t recommend medicines that have so many side effects to them. I honestly think one good surgery, one good excision, I’m not jumping into
surgery for my patients, but one good surgery
can be very beneficial. – Definitely, and I think
that’s one of the other things we’ve been learning just
from all of our experts, including yourself, is that there isn’t one magic bullet, in that we need a team of practitioners. We need a good pelvic PT, we need a good nutritionist, we need a good surgeon. We need community, and those are the things together that will get us, down the line, to less pain and just
feeling better and healed. So let’s talk about flare ups. For your patients, when they’re experiencing flare ups and pelvic pain and really whatever, if it’s endometriosis, if it’s something else, what do you recommend to them, to help with that? – So I think the hard part is I have a lot of women who come in and say, “I’m having an endometriosis flare. “I want another surgery,”‘ when in fact, it’s not their endometriosis that’s flaring. It’s either tight muscles that they haven’t been diagnosed with, or they have interstitial cystitis, which is known as
endometriosis’ evil twin, or they have an upregulated
central nervous system, or central sensitization, so I think it’s important
to really ask the patient to describe what are your symptoms? Because most of the women
who come into my office who feel like they’re having a flare, it’s actually these other
co-existing conditions that were never identified, nor were they treated in the first place. – And that’s, again, why it’s so important to see a specialist like you, who will just open someone up. – I love to operate, don’t get me wrong. I love being in an operating room, but I need to do it for the right reason, and very often, I don’t
need to take a woman back to the operating room all the time. – A few times you’ve mentioned an upregulated nervous system. Would you mind breaking that down for us a little bit further? – Sure. So it’s central sensitization, it’s another name for it. So the way that I
describe it to my patients is that I usually take a step back so they can sort of understand how the central nervous system works, and I tell them to imagine a little kid who sees a burning, fiery red stove, and that little kid puts
their hand on the hot stove, and the message goes up that kid’s hand, up to their arm, up to their spinal cord, up to their brain, their brain interprets that as pain, and send the message back down their hand, and tells that little kid, “Hey, lift your hand up
off the hot stove,” right? That little kid is gonna have a burn on the back of their hand. We call that an acute injury. It maybe will last a few weeks, it’s going to be very painful, maybe the skin will slough off. Maybe after a month or so, the kid won’t be in pain. The kid’s certainly never gonna
touch that hot stove again but what happens with endometriosis, and I think this is, I think my patients really can understand when I describe it this way, I explain to them your endometriosis is a hand on a hot stove, okay? You’re now 36. You’ve been telling me since
you had your first period at age 12, you’ve been
either in the nurse’s office, or in your college dorm, or you’ve had to miss school and work, and so that’s a hand on a hot stove, with messages going
ouch, ouch, ouch, ouch, with no release, right? You can’t let that hand up, and then what happens over time, typically from all that pain, a woman, let’s say, assumes a fetal position, right? They’re squeezing over, they’re hunching. That starts to constrict the muscles. If they have constipation, they’re sitting on the toilet, trying to push out stool
that doesn’t wanna come out, so that’s another hand on a hot stove, essentially going ouch, ouch, ouch, that can’t be lifted. What happens, over time, when you have the endometriosis
hand on a hot stove, and let’s say you have a tight muscle hand on a hot stove, and parenthetically,
women with endometriosis go at least about 10, 11 years from the time they develop symptoms until when they’re diagnosed. So that’s a long time of
these hands on a hot stove. What happens is now the
central nervous system has so many of these inputs that it just starts firing
on its own, essentially. That’s central sensitization. So now, we have a hand on
a hot stove of the endo, a hand on the hot stove
of the tight muscles, and another hand on a hot stove with a central nervous system that’s just so revved up. So we need to address that, as well, and there’s a lot of different approaches. You know, I know a lot
of the physical medicine, where you have doctors, can address that much better than me, but there’s a whole host
of different medicines and lifestyle, all these different things to identify it and treat it. So that way, when you do
have all of these hands on a hot stove, my job is to identify all
the different reasons, slowly lift each hand off a hot stove, at the same time, calm the
central nervous system, or the central sensitization, and then I operate on a patient. So we’re going into surgery with the patient in the best
possible shape as possible, as they can be, as opposed to taking them
to the operating room, with all these hands on a hot stove, an upregulated central nervous system, and then they are in so
much more pain post-surgery, requiring more narcotics, becoming more constipated, as a result of the narcotics, worsening their tight muscles, worsening their overall pain, worsening their central sensitization, so I try and chip away at
all of it preoperatively. – Definitely. Thank you so much for breaking that down. Okay, cool. Well, I think we covered a lot. We definitely have some more time. Is there anything that I didn’t ask you that you would like for me to ask? – I think what’s really important is that it’s not in your head. Endo is somewhat of an invisible disease, meaning you can have an MRI, you can have a CT, you can have an ultrasound. They’re gonna come back normal. Most gynecologists, like I said, their breadth of knowledge is so wide that their depth can’t be so deep. God bless them, right? They do so much, but they’re not gonna
pick up endometriosis. They’re not gonna pick up that most women with endometriosis have intestinal symptoms. Okay, so it’s not in your head, and you really have to
be your own advocate, if you are in pain, that endometriosis could be the source of your invisible pain. It’s not invisible at all. It’s invisible to the doctors and the radiologists, but it’s not invisible at all, and it’s very common, and you really need to be a proponent, to get yourself to an
endometriosis excision specialist, and ask all those questions, because your first surgery is
the most important surgery, and you can learn a lot from these different
online support groups, and don’t give up. I’m actually writing a book right now on how to regain your
life with endometriosis and the prescription, really, is a mind/body approach. It’s head to toe approach, incorporating all the different
disciplines and dimensions that happen when one has endometriosis and then what can you do
to advocate for yourself, with endometriosis? And you can get your life back, you really can. You just have to find the specialist, because the way medicine is these days, you’re a jack of, a master of nothing, a jack of nothing, what’s that phrase? You need to be with someone, who all they know is endometriosis. – Yeah. I like to say an inch
wide and a mile deep. – [Dr. Iris] Yes, that’s a good one. – Would you mind sharing some of your patient success stories? – I have patients who, one comes to mind, and this is very similar, through a lot of my patients, who have had to quit their jobs, they’ve had to move home, they’ve had to have their
parents support them, and then they just thought that, they stopped dating if they
weren’t in a relationship, or their friends didn’t
wanna hang out with them because they didn’t understand
what’s wrong with them, and I’ve had patients, then, get better, become advocates and get amazing jobs, move out of their parents’ houses, and really start living their own lives, and I have that all the time. So many patients who
come to me on disability, who can’t work, and they’re in tears. All they want are kids, and their gynecologist is telling them they need a hysterectomy, one of the false, one of the myths that is a cure for endometriosis, and we basically, we know
that excision of endometriosis can improve fertility, and many of these women, who, you know, have already
tried two, three courses of in vitro fertilization, they often can get pregnant
spontaneously on their own, so whether it’s regaining your life by getting your job back or a new job, and getting back out there in the world, or achieving fertility
that was unavailable or inaccessible before
they came into my office, I have patients who
wanna be in their plays at their high school or in college, and they can’t even follow
or pursue their passion, and then they end up, after the surgery, being the lead in the play, so it could be something
as being in a play, or success at work, or
achieving fertility. But these are thing that
we see all the time, and I just, to caution, it’s not like they’re
gonna come into my office, and with a snap of my finger, their lives are gonna get better. If you’ve had pain for 20 years, it’s gonna take some time
for me to get you better, but if you follow all these different multidisciplinary approaches, you can get better. I think they need to be, women need to be educated, because their gynecologists
are not educating them, but again, it’s no fault of their own. It’s the way the American College isn’t educating the gynecologists. American College of OB-GYN, I mean. – Yeah, and that’s why
I found it so important, to interview you and to
share it with this group, and have this Pelvic Health Summit. Thank you so much for those stories. Those messages of hope are so important, and really healing in themselves. So I know are bi-coastal. Can you tell us where you can find you both physically and also online? – Sure. In L.A., my website is, like L-A-G-Y-N doctor, so, and my office, my new office is actually opening up in
Beverly Hills next week, and I’m moving from
another space I was in, and then in New York, I’m in SoHo, and my
website is, and both my websites have
tons of information on them, and my consultations are very different than any other doctor’s appointment you’ve probably been at. It’s at least about an hour and a half, really listening, doing
a really thorough exam, reviewing everything, and coming up with an individualized, comprehensive plan to help
make each women better, and to achieve whatever it is that he or she wants,
that she wants to achieve. (laughing) Yeah. – Thank you so much for taking the time to be here. This was so informative, and I just can’t wait to
have everyone watch it, and learn from you. Thank you so much. – [Dr. Iris] Thank you for inviting me to be a part of this amazing summit. – Thank you so much for joining us. Now I’d like to hear from you. Please share with us one takeaway from the interview in the comments below. Give us a like, and share this group with someone who you think will benefit. Thank you. (upbeat music)

5 thoughts on “Iris Kerin Orbuch, MD | Gynecological Surgeon | Pelvic Health Summit

  1. While I loved how comprehensive this video was in term of the medicines, treatments, etc, one HUGE thing that wasn’t discussed was cost. I personally met with Iris and she does not accept health insurance so the initial consultation alone was very expensive and for some I’d say the fee would be economically prohibitive. Then you have to add into that the cost of the actual surgery itself which will include the dr’s fee, the hospitals fee, and the fees of any dr’s that will need to come in to address endo found on organs outside of Iris Orbuch’s purview. In addition to Iris I also had a general surgeon who worked on my bowels and removed my appendix and a cardio thoracic surgeon who dealt with the endo on my diaphragm and chest wall. One of the reasons, other than not being well versed in the disease itself, that women have 2, 4, or 8 surgeries is because these were the dr’s that took their insurance AND also promised the patient relief. In the end, I actually had my surgery with Iris’s husband, Dr Laurence Orbuch. While I think he’s an outstanding clinician and equally as talented as his wife, my decision ultimately came down to the fact that he accepted health insurance. I did want to go with someone female and I loved Iris’s approach, I just could not afford the fees involved.

    One thing not spoken about is that endometriosis specialists are increasingly having to decline health insurance because insurance companies are not compensating these dr’s appropriately. Someone who’s done a handful or endo surgery without the years of fellowship training the Orbuch’s have had to invest their time and education into, are getting paid the same amount by the insurance companies. So I don’t want to come off like I’m blaming the specialists for not taking insurance, I’m just trying to explain that it’s just another hurdle to jump in this already grueling marathon of a disease.

    I recently wanted to consult with Dr Laurence Orbuch again regarding some new symptoms that I believe are endo related, and was devastated to hear that he isn’t accepting my insurance any longer either..

    In any case, this video did a great job of explaining this very complicated disease in a way that I think everyone can understand and the fact that Dr Orbuch took the time to sit with you for this speaks volumes of the type of Dr she is and how much she really wants to help. I just wish insurance companies would compensate these dr’s appropriately so that women weren’t having to wait so long to seek appropriate treatment. Sorry for the uber long post… hope it adds a little bit more info into what actually goes into finding a good endometriosis surgeon (besides the fact that there are so few of them!!) ok ok, I’ll stop now. ?

  2. Thank you for this talk! I really appreciated hearing about central sensitization – I hadn't heard of that before and it makes a lot of sense. Where I'm at in my journey is: 27 years of menstruating painfully… very painfully. I've done all the lifestyle changes she talked about and am coming around to the idea that the only way I'll be able to live a normal life is through having a good surgery. This talk helped me to see that I need to move towards that option.
    Shout-out to Nancy's Nook for linking this talk and also for all high quality information <3

  3. Thank you for this informative video. My daughter is 29 and had cauterization done 3 weeks ago as well as insertion of IUD with releasing hormone. Does Dr Orbuch recommend this option?

  4. The information in this discussion has immeasurable value. I was recently told by my doctor that hysterectomy might just be a solution for me. I believed this at face value. I’ve learned the hard way that I must take notes before and during appointments in order to research any medication, medical device, or advice that I discuss in an appointment. If I don’t use peer reviewed, evidence based resources to get answers I can count on misinformation. Even the resources must be scrutinized. If you do your own research , be vigilant and check the funding sources and the amount of patients who participated in clinical trials- and the head count of control group members—as well as the ages and diagnosis of patients and control groups.
    How are our most vulnerable populations able to make their way through our healthcare system, much less advocate for themselves and loved ones. But I know the answer. They can’t and they don’t. For most people, the word of the surgeon is gospel. A smile and 5 minutes of consultation is all most people get, and they don’t know what else to ask anyway. I have spent numerous appointments with doctors who are visibly and otherwise obviously irritated with my questions. If he or she isn’t running or part of a practice which allows for time and thorough examination, consultation, and patient education then I question why so many physicians choose a profession that is about people when so many seem desperate to get out of the room due to overbooking or simply impatience and aversion to talking to their patients. I still have to remind myself that I’m paying for the appointment and that it’s important to take a minute to speak. Yet, I still leave most appointments with something unresolved or forgotten.
    I appreciate the fact that Dr. Orbuch is modeling this approach to being a doctor, a surgeon and a specialist. I hope that the surgeons and women’s specialists who come after her learn the value of healing their patients rather than maintaining illness.
    Thank you very much.

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