Getting Better Outcomes with Endometriosis Excision Surgery with Iris Kerin Orbuch, MD

Dr. Jessica Drummond 00:00:03 Hi and welcome to the Integrative Women’s Health Podcast. I’m your host, Doctor Jessica Drummond, and I am so thrilled to have you here as we dive into today’s episode. As always, innovating and integrating in the world of women’s health. And just as a reminder, the content in this podcast episode is no substitute for medical advice, diagnosis, or treatment from your medical or licensed health care team. While myself and many of my guests are licensed healthcare professionals, we are not your licensed health care professionals, so you want to get advice on your unique circumstances. Diagnostic recommendations treatment recommendations from your home medical team. Enjoy the episode. Let’s innovate and integrate together. Hi there and welcome back to the Integrative Women’s Health Podcast. I’m so excited today to be with a dear friend of mine, doctor Iris Karen Orbach. She is one of the absolute top endometriosis surgeons in the world. So if you’re struggling with endometriosis, you have a friend or family member struggling with endometriosis. If you’re a practitioner of any stripe working with clients with endometriosis, this episode is for you.

Dr. Jessica Drummond 00:01:35 Before we get into it, I want to introduce you to doctor Iris, Karen Orbach, and read through some of her distinguished experiences. She is one of the most experienced people in the field. She is the author of the best selling book, Beating and Know How to Reclaim Your Life from Endometriosis, and is a prominent subject in Below the Belt. So she is the subject matter expert in that movie. And and you tuned in, I hope to that episode with Shannon Cohn, who was one of the executive producers of that movie. So was Hillary Rodham Clinton. And gosh, this was a star studded group. Mae Whitman, Rosario Dawson, and Karen Fox. This movie and this effort to help with funding and better training for people, better training for physicians around endometriosis has been cosponsored in a bipartisan way by Senator Elizabeth Warren and Mitt Romney and the late Senator Orrin Hatch. Doctor Iris sees the value in addressing endometriosis as an inflammatory disease. So this is where she and I really connect. Obviously, I deeply respect her skill set in surgery, and I think that surgery, well done, excision surgery by the best of the best is a key component for healing endometriosis.

Dr. Jessica Drummond 00:03:05 But as we get into in this episode, it’s so much more than that. And doctor Iris has really been outspoken to her surgical colleagues and to other physician colleagues, which is a real challenge to their training to some of the earlier thought about endometriosis. So she really brings in that integrative perspective. Doctor Karen Orbach understands the importance of incorporating integrative medicine and combining Eastern and Western medicine approaches to help her patients heal and get on the road to recovery. Karen Orbach regularly collaborates with integrative nutritionists. She and I work together all the time, so I know that to be true. Pelvic floor physical therapists, pain psychologist, gastroenterologist, acupuncturist, naturopaths, and integrative medicine physicians in order to really help her clients heal from the deep root cause. And she has been a pioneer in this among surgeons. So I want you to tune in in this episode specifically to hear how a surgeon thinks about endometriosis, not just through her vast and long and deep surgical experience with people with endometriosis, but also her own story. And this is very interesting.

Dr. Jessica Drummond 00:04:32 Doctor Iris Karen Orbach, literally one of the best in this field, was medically gaslit so severely that in her own story of healing from her pain that she now, you know, in the same way that I do from having this vast personal experience with navigating the health care system, takes an even better and even deeper approach to the empathy that she’s always had for her clients. But I think you’ll really learn a lot from her personal story as well. And I’ll see you on the other side with some more insights that you can apply to your own practice right away, and to your own healing journey. So let’s get into the episode. Welcome back, everyone to the Integrative Women’s Health Podcast. I’m here with doctor Iris, Karen Orbach. She has been one of the leading endometriosis surgeons for the entire time that I’ve been doing this work, at least 15, 20 years now. And so, doctor Iris, welcome, welcome. And I can’t wait to hear how you got into this, because we all know that endometriosis is not well covered in gynecology training programs.

Dr. Jessica Drummond 00:05:59 Now it’s better because of the work you and Shannon Cohn have done, but there’s still a long ways to go. So where did this interest come from?

Iris Kerin Orbuch, MD 00:06:07 So my passion for the actual surgery was when I was a resident. And actually I think what predated it was I’m a pretty big athlete. So the hand-eye coordination of the sports that I loved playing video games, also hand-eye coordination, those were just things that I absolutely love to do, like Super Mario Brothers saving the Princess as a kid, and then when I was an ob gyn resident and I walked into the operating room where laparoscopic surgery was being done, which is largely hand-eye coordination, and I saw this population of patients who are really suffering and no one was there to help them. And I literally fell in love with minimally invasive surgery and then was fortunate enough to be trained by, I think, probably the two best surgeons in the world, Harry Rich and doctor C Liu, and their passion. They were both at the end of their careers.

Iris Kerin Orbuch, MD 00:07:01 They were so influential in my career from a surgical standpoint. And then a little bit about me. I am a very critical thinker, a very outside the box human like, put me in a box and I will find a way to get out. So from the first grand rounds that I gave when I was actually invited back to where I did my residency at Lenox Hill, when I completed my fellowship, I was reading all the literature on endometriosis, and there was one line in one paper by David Redwine, who also was a mentor. He passed away about a year ago, and it said something like, maybe there’s another cause for pain. It was something like that in a conclusion or a discussion, and it stuck with me. So that must have been 2004 or 5, something like that. And as my practice was more and more focused on endometriosis, I saw these recurrent descriptions of patients pain. And I started to really think outside the box. Start collaborating with pelvic floor physical therapist and nutritionists like yourself and acupuncturists and then urologist and then psychologists.

Iris Kerin Orbuch, MD 00:08:18 And this like the scope just got bigger and bigger. And you have to remember, I’m part of a surgical subspecialty. So the world didn’t want to hear what I had to say. They really thought endometriosis is purely a surgical disease, and I still do believe that the cornerstone of treatment for endo is surgical excision of endo. And we need a multidisciplinary approach to fix those because it’s such a systemic chronic inflammatory disease and disorder. And the symptom onset to diagnosis is roughly a decade. So to answer your question, it’s been part like who I am as a human and part the passion and part like a commitment and part just trying to understand this disease to help so many who are suffering.

Dr. Jessica Drummond 00:09:11 And so essentially, it was an application of your kind of hand-eye coordination, sports video game skill set to do minimally invasive surgery. And then endometriosis became such an interest because it’s really such a challenging disease syndrome for people to overcome. And I, you know, essentially found the same thing that like in pelvic physical therapy, we could get so far until we hit this wall because the situation is so complicated.

Dr. Jessica Drummond 00:09:38 So now we both understand that this is an immune auto inflammatory kind of disease. It’s driven by nervous system and digestive function and gut microbiome. So as a surgeon, as you just said, that was a wildly new perspective. So how do you actually do that. Like how do you start those conversations in your office? You know, when they come to me, they expect some kind of integrative stuff, but when they come to you, they’re really thinking, okay, I’m just going to have this disease surgically excised and then things will be all better. How do you approach those conversations, and how have you started to sway your colleagues? Because many of them have been swayed in the last few years?

Iris Kerin Orbuch, MD 00:10:23 Yeah. So you have to understand, at that time I was practicing in Soho, in Manhattan, and most patients were hoping I was going to cure their decade or two decade long debilitating symptoms over their lunch break. So this was a very difficult conversation in a very upregulated. Hence my move to California, because California is just so much calmer, more parasympathetic, driven than up regulated Manhattan.

Iris Kerin Orbuch, MD 00:10:51 And I love Manhattan and I love my patients, whether they come from the East Coast or the West Coast. But it was a really hard conversation, and I just have always been driven by this principle that like this knowing within me and this just to really challenge my patients and to challenge the status quo. So it was not easy. Like I fought against surgical organizations who didn’t want to hear about the multi-discipline. They didn’t want to hear anything about nutrition, gut mindfulness, you know, pelvic floor PT. I remember even like when was it I was heading one of the postgraduate courses at one of our big meetings. And I remember I fought to bring a physiotherapist as one of my faculty, like I fought and I got a pelvic floor PT as well as one of my faculty at a surgical organization. By the time I finished that postgraduate course, I felt like I lost a year of my life. But it was such a pivotal thing to make that happen. And I feel like that exhaustion, it took me about ten, 15 years of like, literally, I felt like a salmon swimming upstream.

Iris Kerin Orbuch, MD 00:12:03 But I knew it was right because I was starting to see outcomes that no one else was seeing as I was incorporating all of this stuff. And I think what happened over time, people really started to trust me, and they saw that I was, you know, really in their corner and they were hopeless. And they’re like, okay, I’ll try it. And then as they started to feel better, then there was more of a trust. And then, you know, the biggest collaboration came by non physicians like physical therapists, nutritionists, psychologists, acupuncturists and then some out of the box urologist out of the box, desirous like that’s where the true healing there was this collaboration. So it was a really tough, difficult thing. And I just did it because I knew it was right, like I had this knowing. I have this like intuitive power for healing both myself, my family and my patients. And it’s been spot on. Yeah.

Dr. Jessica Drummond 00:13:09 You know, there’s so many parallels in our experiences of like going from a very kind of Western Ivy League kind of training, you know, as you said, like, this is the answer.

Dr. Jessica Drummond 00:13:23 This is the answer. All we have to do is cut out these lesions. The better we do that, this is the answer. And then kind of fighting with these organizations about no, the answer is a lot more nuanced and complicated. And it’s different in every patient. And we have to kind of bring in these teams, you know, it’s the same kind of thing that I encountered. But I agree with you that about 15 years ago there was, I think, a group of people from all different disciplines who started to realize, yes, this is how this is. We’re not going to have like a one quick fix. It’s not just a diet, it’s not just a surgery. It’s not just a pelvic PT intervention. It’s not just mental health support. It’s all of these things. And so later. So I want to ask you two things. I think I’ll start with this. So later, you experienced your own diagnosis of endometriosis when you were in your perimenopausal mid to late 40s.

Dr. Jessica Drummond 00:14:23 I think one of the interesting things that I’m seeing in my practice now is that I’m seeing more new onset, if you will, endometriosis in perimenopause. And my theory is that some people really are like that’s when their endometriosis is triggered sometime because of perimenopause. But I think for most it’s actually just that the diagnosis was missed for 2025 years. What are you seeing and what was your experience.

Iris Kerin Orbuch, MD 00:14:49 So it’s so funny because the healer has to heal herself. So I actually had symptoms after the birth of my. Thankfully, I had two daughters spontaneously, and I started experiencing symptoms after my second daughter was born. So I actually had debilitating pain for 16 years while I was healing others. And you know, people come to me for their expert opinion, but the person who I went to told me totally gaslit in my pain, totally told me no, you’re manifesting your patients pain. No, you don’t have pain. Boy, I’d love to share who that is, but I will never reveal who that is.

Iris Kerin Orbuch, MD 00:15:33 And that’s why maybe I understand my patients so much. Because I believe this external figure who was telling me that. No, I don’t have pain. No, I don’t have pain and no, I don’t have endometrium cis. So that led me to start healing myself through all these different disciplines. So I had been recommending pelvic floor PT for years at that point, and I got to a breaking point of debilitating pain, meaning I’m doing tons of surgeries a week, I’m helping so many people and I’m like, where am I going to get help? And I landed in Beyond Basics, Amy Stein’s office. One day I called her. I’m like, I don’t know what’s going on with me. That began my pelvic floor PT journey, then my gut journey that, you know, every single one of these things. And then I finally listened to myself and knowing, well, what happened actually is my older daughter, and she’s written about this extensively. When she was nine, she started having debilitating GI symptoms.

Iris Kerin Orbuch, MD 00:16:36 And again, none of the doctors believed her. And I’m like, she’s got endo. My specialty is teens with Endo. She has that same person who told me that I don’t have Endo told me she doesn’t have endo this time. Like a mother’s intuition is very different and I’m like, I know my knowing she has endo. So, you know, I started all those things, other disciplines. And eventually as a teen, she had excision surgery and it was a game changer for her. But it wasn’t only the excision of Ando, it was the integrative nutrition. It was the pelvic floor. PT it was a somatic work mind body, which is the same thing that I utilize, same thing I recommend to my patients because when you have pain for years, it’s like the endo that starts it. But then there’s all these downstream things that we need to undo. And my daughter has written like this great article called it appeared in Stylecaster. And, you know, she calls Endo this invisible foe.

Iris Kerin Orbuch, MD 00:17:34 And even though I had said to her, I know you have endo, I know you have endo, I know you have. And we flew in the midst of Covid. To have her surgery by an amazing excision is and I knew my knowing. And it wasn’t until she got to the recovery room where the surgeon told her, yeah, you had endo, that she kind of like believed it. And then once she was diagnosed, knowing the incidence of the daughter has it, the mom probably has a 700% likelihood. Then what? I then said to the surgeon, I’ll be back.

Dr. Jessica Drummond 00:18:05 Yeah. Well, and that’s an important point, because you and I both work with a lot of young women in their teens, 20s and 30s. And then I also later see their mothers because it’s like, oh, well, I didn’t have her infertility. I didn’t have, you know, some of these other things. So it couldn’t have been endo. But then as soon as their daughter has that confirmation, the mother’s like, oh yeah, the fact that you were so powerfully gaslit shows how ingrained that is into our entire system.

Dr. Jessica Drummond 00:18:43 Because it was your training, it was your mentors, it was your colleagues. It was your own mind to even be able to believe that given the soup that we all live in. And I think that’s so helpful for people to hear because they’re not crazy. They really aren’t.

Iris Kerin Orbuch, MD 00:19:03 And that’s why I share my story, to help other people. And I understand them. My heart hurts as I am hearing them saying, my doctor told me to have a glass of wine before sex. My doctor told me this. My doctor told me it couldn’t be endo. I’m too young. All of these myths and then the denial. And then the patients. When I validate them in the office, I’m like, based on my exam, I can tell with 90% likelihood whether a patient has endo. And when I, you know, push on certain things and I’m feeling the endo, it’s like it’s only that awareness where then they start tearing crying and they almost still don’t even believe it, even though I’m telling them.

Iris Kerin Orbuch, MD 00:19:43 And the biggest question just to lastly to say is I’m doing my pre-op for my patients. The question I get the most is, what if you don’t find endo? And I’m like, that’s the question everyone asks me. And I tell them, I wouldn’t be taking you to the Or if I didn’t think that you didn’t have endo. And I’m like, I really think there’s a 90% likelihood that you have endo. And it’s just like this. It’s such an uphill battle and like, my heart really goes out to all those who are suffering.

Dr. Jessica Drummond 00:20:13 Yeah. Now, I think it’s important to just mention every once in a while someone doesn’t have endo, but I still think everything we’re talking about today, you know, addressing the gut and addressing the pelvic floor through PT, even looking surgically for something else, which it could be, you know, the immune function which can show up as like the structural challenges, whether it’s adhesion or something else. I think even if someone doesn’t have a diagnosis of endometriosis, if they have discomfort and in most cases it’s significant pain, digestive issues, all fatigue, menstrual health challenges, all of the symptoms.

Dr. Jessica Drummond 00:20:54 We now know there’s this whole suite of things we can do, including mind body medicine, which doesn’t mean that it was like in your head. It just means you didn’t have that particular lesion. So maybe that will help take the pressure off a little bit.

Iris Kerin Orbuch, MD 00:21:09 Yeah. Anyways, before I take someone to the O.R., I’m down regulating mind, body, gut, all of that stuff. And they typically are benefiting from all of those things. And then typically in that less than 10% where I’m not finding endo, I’m usually finding something else in the surgery that is the answer to their pain. And they’ve already benefited from all of that rehab that I’ve done.

Dr. Jessica Drummond 00:21:34 Yeah, absolutely. So one of your specialties, which I think is so important because these are some of the people that gaslit the most are teen tween girls, girls in their young 20s who were in college. Tell me how you might approach that differently a little bit. You know, compared to, say, a woman you’re meeting in her 30s?

Iris Kerin Orbuch, MD 00:21:56 Well, I think because I have two daughters, I have an 18 and a 21 year old.

Iris Kerin Orbuch, MD 00:22:00 And I think my kids friends think of me as the cool mom. I know how to interact with teens. I’m very young at heart. I’m like a kid myself in terms of just my interests and my advice. And I think just meeting them at their level, in whatever their level may be, and meeting them at what they’re willing to do and taking it as slower quickly as they feel that they’re ready to go. I think also, there’s something about safety that the teens feel with me is I’m like, I got you. I’m here with you on this journey and I’m never going to give up on you. And like, whatever that may be, it may be slower, quicker or whatever it is. It may be starting one thing at a time, very slowly. This is how it’s got to be. You got to do it my way. I’m resisting how they want to do it. I’m meeting them where they’re at and then figuring out how to apply things the way that they live their lives.

Iris Kerin Orbuch, MD 00:22:59 And I think that that’s really helpful for them.

Dr. Jessica Drummond 00:23:02 Yeah, absolutely. So if you think about kind of endometriosis, the state of where we are in terms of awareness of this disease, helping women who are struggling with it think they might be struggling with it, want their practitioners to take them more seriously, Their families? What are some suggestions you have for either individuals potentially living with this, or practitioners who are taking care of them? In terms of what we really know, that you don’t think we’re addressing enough in the day to day.

Iris Kerin Orbuch, MD 00:23:34 So just how to arm their providers with information to help them heal. Is that what you’re.

Dr. Jessica Drummond 00:23:41 Yeah. Like how to let them know how to maybe give them resources, things like that. Because I think unfortunately, still in most places it’s up to the patient to educate the provider. Correct.

Iris Kerin Orbuch, MD 00:23:53 And that’s why I wrote my book, Eating Endo How to Reclaim Your Life from Endometriosis. So it is a guidebook for patients wherever in the world they are. If they’re living in a rural village or a major metropolitan city, they are taking this guidebook of my book to their gynecologists and saying, can you write me a prescription for pelvic floor PT? This book shows the correlation.

Iris Kerin Orbuch, MD 00:24:17 Here’s the studies, blah blah blah. Taking it to the GI, can you, you know, test me for small intestinal bacterial overgrowth or taking it to the nutritionist who’s a mainstream nutritionist saying, can you like look at my large intestinal health or whatever it is? There was one line in the first movie that Shannon Cohn made, which was End of What I think that premiered in 2015, and we had worked on it. I don’t even know, ten years, eight years before it came out. I don’t even remember. That was an uphill battle to like for that movie to come out. And it was crazy. And that was the beginning of this train that was very slow moving to move. And there’s one line in that movie by Mary Lou Balog, who’s the head of the Endometriosis Association, which is founded in Milwaukee. That was one of the first endo organizations. And she really looks at Endo as an immune dysfunction. She was looking at it really early on before anyone was at that time, Mary Lou and I became very close when I was a resident.

Iris Kerin Orbuch, MD 00:25:23 And her pearls of wisdom, I think, also sparked my like, And there’s a line that says, you have to know your disease better than your doctor. And when I first was reviewing all the cuts of the movie, I didn’t understand that. Like, why does the patient need to know that more than their doctor? Because I knew a lot. But what I realized over time was most people don’t have access to like a specialist like myself. And we do need to know more than our physicians to challenge them. Anyways, the book was written as a guidebook to help challenged doctors, because it’s easier to get patients to drive a change in the way we’re treating than to treat doctors, to like, get doctors to change the way that they’re treating patients. So the decision really was like, let’s empower the patients to help themselves, because that’s going to be the best way to affect change. That took a lot of years of trying to figure out how to tackle this delayed diagnosis.

Dr. Jessica Drummond 00:26:26 Yeah, it’s frustrating, but it’s true.

Dr. Jessica Drummond 00:26:28 It’s very hard to move the slow moving ship that is the health care system and all the different kind of distinct parts of it. So let’s circle back a bit to having your diagnosis and perimenopause. So you’re also probably navigating perimenopause at the same time that you’re thinking about surgery. So for women who are listening to this or their practitioners who are working with women in their 40s and 50s who either never had their endometriosis addressed, or maybe the hormone shifts of the time, or even just getting sick in perimenopause. You know, one of the things I’m seeing now that we’re in a Covid environment where everyone’s had this new immune regulator, and when we now know more about Lyme mis being triggered by herpes viruses and things like that. So this kind of relatively more pathogen toxic and also environmental toxic soup that we’re living in, I think there are some people who just didn’t get the trigger until they were in their Perimenopausal years. So how would you think of that now? What are some of the things those women should be thinking about a little differently than if they’re in their 30s?

Iris Kerin Orbuch, MD 00:27:41 So I think I love that you’re bringing up just the whole viral bacterial, Lyme, all autoimmune disease.

Iris Kerin Orbuch, MD 00:27:49 It’s like yesterday, just about every one of my patients I saw in their office not to get off track, but has a new diagnosis of Pots. They have a new diagnosis, maybe of mast cell activation. They are being mandated by their primary care doctors, and no one is putting together this whole what’s the ideology of all of this? So that could be like a whole nother discussion that I’m so interested in. And I can’t stop reading about all of this, but I think, you know, for me, I wasn’t even perimenopausal yet, even though I was like around that age. But it’s tough to know, is it? Because all the hormones are affected by all of these things, whether testosterone starts to decrease. All the hormones get thrown off because everything’s being thrown off from the brain and the hypothalamus and the pituitary. I don’t know, is that the trigger, in combination with the natural shifts and the decrease in our own hormones? Which ones? The onset. Which one? I don’t know, but yes, it’s hard to know because my patient population tends to skew much younger than the menopausal age.

Iris Kerin Orbuch, MD 00:29:03 And that could be because I specialize in teens and 20s. I mean, though I see all endometriosis patients, there’s more social media out there for earlier diagnosis. So I haven’t seen like that mid 40s to early 50s spike in my practice. That was the age group I used to see ten years ago for console, so it’s hard for me to tell. I totally agree with what you’re saying. I just don’t see that so much in my office.

Dr. Jessica Drummond 00:29:34 Well, and I think what you’re saying is so important, the good news that we’ve had in the last 15 years with Endo, what with the onset of kind of conversations like this on social media, is that women who are in their teens and 20s, women and girls in their teens and 20s, are recognizing that they might have endometriosis and then pushing that change to their primary care doctors, to their gynecologist. So, I mean, there certainly are communities that are lagging their communities that we need to further address. But the diagnosis and just the word, you know, the disease, state of endometriosis is more readily understood.

Dr. Jessica Drummond 00:30:13 So we are getting some earlier better treatment, which is good. And I think, you know, I really do think that from my perspective, because of course I see all the people that are very challenged with these huge buckets of issues, that Covid virus, because we know it lives in reservoirs for at least a year, maybe two. Based on the data we have, and then maybe forever, simply like, you know, similar to Epstein-Barr and other pathogens, could be driving some of the autoimmune related issues of endometriosis in combination with any of those other pathogens. And especially when you think about Pots and macaques, you know, this sort of new, we used to call it the terrible triplets of endometriosis, bladder pain and vulvodynia. I think there’s sort of a new terrible triplets that maybe was always happening, and we weren’t looking for it as much because you and I were talking about histamine probably eight years ago at the Endo summit. But it’s new for again through social media, which I think is a good thing for people to be recognizing when they have Pots or some kind of dysautonomia MCAS.

Dr. Jessica Drummond 00:31:26 So the new terrible triplets of endo MCAS and dysautonomia and hypermobility seems to be what I’m seeing all the time. And I don’t know if we just weren’t looking at it before or because of the new pathogen environment. It’s happening more often.

Iris Kerin Orbuch, MD 00:31:42 I think the latter, I really think it was there and I was seeing it, but not as often. And I was picking up on it on my patients who had multiple autoimmune issues. They were reporting these hives, they were reporting all of these things. So I saw it happening in my patient population. But it was I think Covid just being so prevalent is what accentuated it. I actually heard such a fascinating podcast about two weeks ago by this long Covid specialist, who was, I think, at Kaiser, and then maybe UCLA. I’ll send it to you. And she is finding help in helping her long haul Covid patients with pain reprocessing. So fascinating. So I’m really delving into that to learn more about it, to see what I can do to help my patients because there’s such an overlap.

Iris Kerin Orbuch, MD 00:32:37 Yeah.

Dr. Jessica Drummond 00:32:38 Yeah. Because I think both, as you were just mentioning, start in the brain. Right. So or maybe are driven at least to the brain at some level. So when you can help regulate vagus nerve and autonomic nervous system I think that’s the key to the rest of it. Then of course, we still have to get rid of the viral persistence and we still have to regulate the immune system. But it’s almost like you can’t do those things and have them stick until the nervous system is more regulated. So to wrap up this conversation, when we think about nervous system regulation, you’ve for years emphasized this for your clients pre-surgery. And obviously that makes it easier post-surgery. What are some of the best recommendations you have for clients who are preparing for surgery when it comes to healthfully regulating their nervous systems?

Iris Kerin Orbuch, MD 00:33:29 Yeah, so when I meet my patients on initial consult, one of the first things I have them do after I explain endo, I explain this multidisciplinary approach. I give them a meditation challenge and I give them the data that because I explain how pain like part of it is the way the brain is processing pain, part of it is true organic pain.

Iris Kerin Orbuch, MD 00:33:50 And that’s a whole long discussion. But I give them a meditation challenge and I tell them that the data is around. If you meditate the same time every day for six weeks, there’s great data to show. That begins to be a rewiring of the brain and pain is doing meditation is free. It’s free. Meditate. So something that you can do at home, it’s portable, it’s cheap. So I get them meditating from the beginning. I try and get them to sleep at reasonable hours. I try and get them to eat more of like an autoimmune, healthier, you know, get them in with an integrative nutritionist. I definitely think working with a pelvic floor PT who understands breathwork mind body, helping patients have an awareness within their body because most of my patients are actually outside of their bodies, like to escape the pain in so many ways to like. So to kind of bring them back into an embodied state. I think educating them to understand their pain. And the one thing is healing from surgery doesn’t take two days or three days like most surgeons tell them.

Iris Kerin Orbuch, MD 00:34:54 It doesn’t take a week and you’re back at work. You’ll be right there. Like I let my patients know that whether you fall and skin your knee on a bike or you have surgery, the physiology of healing is the same. It takes six weeks for 60% of the healing to be completed in three months for full healing. But it doesn’t mean that you’re going to be better in six weeks or three months. It’s how many pain generators do you have? How many are converging? It’s very individualized, but I give themselves time to heal.

Dr. Jessica Drummond 00:35:23 Yeah. And having some of those tools at their disposal, like just consistent a few minutes of meditation every day is a really good way to do it because, as you said, it’s accessible to everyone. Yeah, I love that. So what’s next for you and how can people reach out and learn more about your work and come see you as a patient? How can they find you?

Iris Kerin Orbuch, MD 00:35:48 I’ll start with where they can find me. So I’m in California, in Los Angeles.

Iris Kerin Orbuch, MD 00:35:54 I do virtual consults all over the world as well as in person. They can find me on Instagram, which is doctor Iris or Book Doctor Iris Orbach, or my website is Lynda.com or la.com. Call my office. I would love to see you as a patient. I have a lot of exciting stuff coming down the pipeline that I can’t share just yet. I have so many things that I’m working on and excited to announce in time. I just need to make sure everything’s like in a good place. But yeah, I have a lot of really integrative things coming down.

Dr. Jessica Drummond 00:36:34 That’s That’s fantastic. I’m excited to see it. So go follow doctor Iris, Karen Orbach on Instagram and your website. And we’ll also include links with the show notes for your book, because I do think every person with endometriosis should carry that to all their doctor’s appointments, especially if they’re feeling gaslit by anyone and know that your deep knowing is really what saved your and your kid’s health. And so if people are questioning their deep knowing, you can trust it.

Dr. Jessica Drummond 00:37:10 That’s really where it all begins. So thank you so much.

Iris Kerin Orbuch, MD 00:37:15 Let’s thank you for having me. I so appreciate like just the conversation.

Dr. Jessica Drummond 00:37:19 Yeah. As always, thank you everyone for being here with us. And I’ll see you next week on the Integrative Women’s Health podcast. Thank you so much to doctor Iris, Karen Orbach for joining me today for that portant conversation. For anyone living with endometriosis, suspecting you have endometriosis, living with a family member or friend with endometriosis practitioners working with endometriosis. Here’s a key takeaway that I want you to think about as you go back into your practice, or back into your conversations with your doctor. Endometriosis has neurologic and immune, inflammatory, and autoimmune components. While removal of the lesions through precise, skillful excision Surgery is essential for most people to fully recover from endometriosis. It’s a cornerstone in our treatment regimen. As you just heard, one of the most important things we can then address is this sensation of safety in the body. So we have to do that with physical tools such as optimizing nutrition and movement, myofascial work and supplementation, optimal digestive functioning, and via addressing trauma.

Dr. Jessica Drummond 00:38:45 And that can happen in so many different ways that can happen through talk therapy, that can happen through somatic therapies, that can happen through a physical movement, that can happen through journaling, through mindfulness. So take away one tool. Whether it’s the meditation recommendation that doctor Iris gave in this conversation, or any other tool that aligns with you to help you feel more safe and regulated in your nervous system. As you well know, our seven step system here at the Integrative Women’s Health Institute starts with step one nervous system regulation, but not just for the patient or the client, but more importantly for the practitioner. So if you’re working with clients with endometriosis or any other autoimmune inflammatory challenge part of your work, part of your job is to do your own practice of regulation so that when these clients are in your presence, just being in your presence will help them to regulate. And if you want to learn more about how to do that, we’ll also include in the show notes a link to more information about our Endometriosis Certificate program.

Dr. Jessica Drummond 00:40:08 It’s key for every practitioner who works with clients with endometriosis to have that fully integrative perspective. So go and check that out. Thanks so much for listening this week and I look forward to seeing you next time. Thank you so much for joining me today for this episode of the Integrative Women’s Health Podcast. Please share this episode with a colleague and if you loved it, hit that subscribe or follow button on your favorite podcast streaming service so that we can do even more to make this podcast better for you and your clients. Let’s innovate and integrate in the world of women’s health.