The new website is designed to give patient essential information about our practice location @ 18 east 41st Street.

The new practice location is in a premier midtown location only 2 blocks from Grand Central Station. The office is just 1/2 block away from the NY Public Library.

Our new location will offer women the convenience of a great location and the straightforward hassle free service required fit your women’s health visit into your busy day. Patient will continue to be able to access our award winning patient portal in order to communicate with their physician, request prescriptions and schedule appointments.

Pur phone number is the same 646 290 9560 and you can still make appointments through our portal or via ZocDoc.

Endometriosis is a common disease. It causes infertility, inflammation, painful intercourse, painful periods, bladder problems, pelvic floor problems and bowel problems among others.  

I always have to ask the question – why, if so many women have endometriosis do they not all have pain?

That’s correct – not all women with endometriosis have pain. As a busy gynecologic surgeon I frequently see endometriosis (and prove it with a biopsy) in women who are having surgery for other problems such as fibroids and cysts. They may have no pain complaints but they definitely have endometriosis.

The general answer to the question is that different people have different thresholds for pain. Pain in and of itself is a complex disease. We are just beginning to scratch the surface in our understanding of pain as a disease. So, rather than focus on endometriosis, when present,as the sole disease in a women with pelvic pain I believe it is important to treat endometriosis as a critical pain generator in such patients.

This way of thinking allows me to treat endometriosis and at the same time consider underlying pain mechanisms in a patient in whom not all pain may be accounted for by endometriosis. This way of thinking allows me to manage women with much more complex pain problems than simply managing endometriosis would allow.  Further, it guides my understanding of the best way to intially manage endometriosis.

If endometriosis is thought of as a pain generator that over a long period of time can effect the way the central nervous system (brain and spinal cord) views and handles pain signals then one must come to the conclusion that the best way to manage such a pain generator is to remove it. A poor way to manage such a pain generator is to put a hormonal band aid (such as lupron) on it and expect great long term results.

So, in my practice I have become a nationally recognized expert at removing endometriosis. I call the procedure a fertility sparing (for women who wish to retain their fertility) radical resection of endometriosis. During this procedure I remove all visible areas of endometriosis. In doing so, I go all the way to the root of the endometriosis lesions. I sometimes have to remove endometriosis from the ureter and sometimes from the bowel and areas in between the vagina and rectum. Sometimes the endometriosis is so severe that I call in a colorectal surgeon to remove a portion of bowel.

Having said all of that here’s my advice in choosing an expert to manage your endometriosis and pelvic pain:

1. Choose someone who has advanced skills in laparoscopic and robotic laparoscopic surgery. Generally, people who focus on gynecology and gynecologic surgery only may be qualified. Ask your surgeon is he or she is able to perform the surgery as described above.

2. Choose someone who understands and can manage all the aspects of pain associated with endometriosis. If your surgeon says, “I only do removal of endometriosis” then it is likely he will miss other pain issues that will crop up later. This single modality approach almost never works for long term relief.

3. Choose a doctor who isn’t afraid to explore the possibilities and work with doctors in other specialties. Pain is a problem that can effect your entire body and multiple systems. Just because you have endometriosis  – this does not have to be your only problem. To treat patients with endometriosis as if it the only problem is too narrow and poor practice of medicine.

4. Choose someone who takes your insurance. There are several qualified surgeons across the NY area who can manage these problems effectively. There is no reason to shell out more than $20,000 when you can do it for a $15 copay. Arguably, the surgeons such as myself who do take insurance carry a higher level of ethics (because we are not in it for the big money) and are more experience because we see more patients.

I wish you the best of luck in your search for relief from your pain. Please feel free to visit our website -

www.pelvicpainnewyork.com. You can always reach me directly drlevey@pelvicpainnewyork.com

Click Here to  Learn More

A myomectomy is a procedure performed for the removal of fibroids. This is a procedure that in most cases can be performed laparoscopically with advanced robotic technology. This sounds simple doesn’t it? So, why do I find myself in my office counseling most of these patients that the best and safest surgery for them is a hysterectomy (remember – a hysterectomy does not mean removing the ovaries)?

I have no desire to remove a woman’s uterus if it is not necessary. I have built my practice on allowing my patients to choose from a menu of options. It is not about money because I certainly do not get paid more to do a hysterectomy. And it is certainly not about my enjoyment of surgery because a difficult myomectomy is far more interesting to me than a hysterectomy. So, what’s the story?

This all comes down to one very important concept in surgery and surgical decision making – RISK VERSUS BENEFIT.

In performing a myomectomy on a large uterus with multiple fibroids (evenif it is done with an open technique) there can be very large amounts of blood loss. Is it really worth the risk of massive blood transfusion, possible transfusion reaction, hypovolemic shock, blood transfusion associated infections, possible need for an intensive care unit stay just to perform a procedure that saves an organ with no future value (ie childbearing)? I don’t think so and I think most of my patients agree.

In performing a myomectomy on a large uterus with multiple fibroids there can be at least double the infection risk for post-operative infections versus a hysterectomy. Is it really worth the risk to have to possibly go back to the operating room for repeat surgery, abscess drainage, prolonged hospital stay, prolonged IV antibiotics and possible need for hysterectomy to treat the infection? I don’t think so.

So, when we are counseling you to have a hysterectomy instead of a myomectomy and you have no desire to have children in the future – it is for your safety and benefit.

Please feel free to email me with any questions – drlevey@pelvicpainnewyork.com. I am happy to review your imaging and set up a phone / video consultation or see you in the office to find the best way to manage your fibroids.

Based on this knowledge, I tend to agree with the authors’ conclusions that women with preconceptionally diagnosed endometriosis should be seen and managed (at least in consultation) by a board certified perinatologist (maternal fetal medicine specialist).

The (Well Sort Of) Interesting Article

In this months journal Human Reproduction there was a very interesting article that evaluated a diagnostic test for endometriosis. They compared endometrial biopsy (the endometrium is the inner lining of the uterus that is shed every month during menses) samples for the amount of microscopic nerve fibers and compared that to specimens obtained from inside the abdomen.

Currently, obtaining samples from inside the abdomen is the gold standard for diagnosing endometriosis. This requires an experienced laparoscopic surgeon and endometriosis diagnostician to obtain the proper sample. However, obtaining a sample of the lining of the uterus is very simple and requires no surgical skill in laparoscopy. So, there is a clear advantage to using endometrial biopsy if it proves to be a useful diagnostic adjuvant.

The current study suggests that there is a high degree of correlation between nerve fiber density on the endometrial biopsy specimens and the finding of endometriosis inside the abdomen and pelvis. If we could use endometrial biopsies to better diagnose endometriosis it would save a lot of patients from having unnecessary surgery and it would help us better plan for surgery in patients who do need surgical intervention.

I am reluctant to start using and relying on this technique at this time as this study has several weaknesses. There were weakness in their samples such that the overall quality of their samples we low (only 25% were “satisfactory”). They said in their article that they did not have all of the possible biopsies from inside the abdomen. Thus, they made some correlations based on visual diagnosis only – this creates a significant problem because instead of comparing apples to pears they are now comparing apples to pears plus oranges – further confounding the data.

I look forward to further study of this very promising technique.

· Herbs were administered after menstruation. The authors reported a 72% reduction in the quantity of menstrual blood. Symptoms like abdominal pain, and backache were improved in 58.8%. The overall effectiveness rate was 92.4%. Myomas completely disappeared in 13% of the cases, were markedly diminished in 29%, slightly reduced in 19%, and unchanged in 28%.

Acupuncture is also recommended in the treatment of fibroids. Stimulation provided by acupuncture has been found to reduce proliferating fibroid cells.

Other natural treatments (potentially useful for symptoms associated with endometriosis), include:
· Rest and wear loose, comfortable clothing
· Perform deep breathing exercises and meditative practices
· Take warm baths (with aromatherapy if you wish.)
· Use essential oils like frankincense, myrrh, clary sage, peppermint, lavendar, rosemary,
juniper and thyme.
· Use a heating pad or hot water bottle on your abdomen
· Apply warm castor oil packs on your abdomen to invigorate the blood, assist the lymphatic
symptom and balance hormone levels. Apply warm castor oil to the lower abdomen and
cover with plastic wrap two to three times per day during the premenstrual and menstrual
period.
· Take herbal supplements that invigorate the blood (and those for resolving concomitant
patterns as applicable.)
· Avoid all foods which have been treated hormonally.
· Consume soy and soy products like tofu.
· Buy only organic fruits and vegetables.
· Avoid refined, rancid and hydrogenated oils.
· Use only unprocessed plant sources of essential fatty acids.
· Use oils rich in both linoleic and alpha-linolenic fatty acids such as flax-seed, pumpkin-seed
and chia-seed oils, but only if they are recently cold-pressed and refined.
· Include dietary spirulina, evening primrose oil, and oil from black currant and borage
seeds.
· Avoid sources of arachadonic acid, which comes from animal meats, dairy products, eggs,
peanuts and seaweed.
· Decrease the amount of dietary animal products, except fish.
· If you do consume meat, make sure it is at least organic, and not hormonally treated.
· Eat walnuts, dark greens, saffron and cold climate crops.
· Foods which are especially good for resolving blood stasis include: Kelp, lemons, limes,
onions, Irish moss, and bladderwrack.
· Antioxidants (vitamins C, E, beta-carotene, selenium, zinc)
· Super antioxidants (grape seed extract, pine bark extract, red wine extract, bilberry
extract)
· Omega 3 fatty acids (fish oil and linseed oil)

Most of the time when there is pelvic floor dysfunction it is secondary to another problem. That other problem may be a persistent problem such as endometriosis or an acute problem that has already been resolved such as a urinary tract infection. In either case, the pelvic floor muscles are acting to protect the underlying tissue from a perceived injury (as they would do with a broken bone for example). This spasm can long outlast the initial injury and become a chronic problem independent of the initial injury.

I have been recommending pelvic floor physical therapy to patients with many different types of underlying pelvic pain problems. This is often a critical adjunctive therapy (and sometimes the primary therapy) used to help patients improve their overall pain picture and improve their quality of life.

I hope this helps to better explain the need for physical therapy for certain pelvic pain conditions.

Although it may seem counterintuitive, physical activity is actually an important part of any program for managing chronic pain. While the thought of moving more while you are in so much discomfort might seem out of the question, evidence shows that regular exercise not only helps to reduce the pain that you feel, it can also improve your outlook and change the ways that you cope, mentally and emotionally, with your condition.

How can physical activity help to keep my pain under control?

There is a wide body of research which indicates that exercise has numerous benefits for individuals who suffer from chronic pain:

• · Women who exercise regularly generally require less pain medication for the same amount of pelvic pain than women who do not participate in physical activity.
• · Targeted exercises not only strengthen the muscles of the pelvic floor, but also increase blood flow to the area, which may help to reduce some types of pain.
• · Regular exercise helps to decrease body weight, reducing the amount of stress on the body and improving your overall health.
• · Exercise has been shown to help regulate brain chemistry and alleviate the symptoms of depression; this can have a pronounced effect on how women perceive the pain they are experiencing and how they are able to cope with it in their daily lives.

What kinds of exercises should I do?

Dr. Levey recommends a combination of cardiovascular (aerobic) exercise and strength training; how much of each of these you do depends on your personal circumstances – the cause of your pain, your overall physical health, and other factors that you and your doctor will need to take into account. In addition to these, your doctor may recommend certain exercises that focus on the muscles of the pelvic floor. Before you begin any exercise program, it is important that you talk to your doctor about the type of exercise that is most appropriate for you – he or she may refer you to a physical therapist that can help you design a personalized exercise program.

Should I still take my medication?

Under most circumstances, exercise will be part of any pain management program. If your doctor has prescribed medication for your condition, you should not stop taking it unless under the recommendation and supervision of your physician.

If you are experiencing chronic pelvic pain, don’t let it get in your way. Even if the pain is not related to any specific, curable condition, there are a variety of things you can do to manage the pain and feel better as you go about your daily activities. Talk to your doctor about your symptoms; he or she will be happy to work with you to figure out how to improve your quality of life.

Call us @ 646 290 9560 to make an appointment to discuss exercise and pelvic pain. Dr. Levey or Dr. Ostrov will be able to answer your questions.