Interview : Dr. Caroline Appleyard

CBA

Many of you have read my blog entry Stress Levels May Affect Endo, which can be found here. In that blog, I mention Dr. Caroline Appleyard, her colleagues, and their research.  Dr. Appleyard and Dr. Flores have agreed to answer some questions I’ve posed to them.  Dr. Appleyard previously answered a few questions, and now has submitted additional information:

Q&A Session with Dr. Caroline Appleyard

There are so many theories regarding the cause of Endometriosis.  Which theories have your studies caused you to focus on as the cause?

Our research so far falls in line with Sampson’s theory where there is retrograde flow of menses through the fallopian tubes and then for some reason in endometriosis patients the tissue is able to implant and grow where it shouldn’t.  However the research in my lab is more focused on trying to intervene with the exacerbation of the symptoms based on our hypothesis that in endometriosis patients there is some imbalance in the hypothalamic-pituitary-adrenal axis which is normally responsible for controlling reactions to stress and helping to ‘reset’ the body defense mechanisms.

Do you feel that Endometriosis symptoms can be controlled by diet and supplements?

I think that, as with many chronic conditions, a healthy balanced diet can perhaps contribute to some alleviation of the symptoms. It is important to ensure that patients as not lacking any vital nutrients, and I have seen some anecdotal reports suggesting that cutting out certain sugars or fats might alleviate some symptoms, particularly any referred pain from motility disturbances. For example in some cases a patient might have very similar symptoms to those found in Irritable Bowel Syndrome where quite often diet modification can help with changes in bowel motility which might be causing discomfort. If a patient thinks that their intake of certain types of food seems to correlate with exacerbation of their symptoms my suggestion would be to keep a food diary and then discuss this with your physician to also rule out any additional gastrointestinal issues.

How do you feel about hysterectomies as a cure for Endometriosis?

I do not have the clinical expertise to comment on this but know that hysterectomy of course has a large impact on the body with a whole slew of other consequences.  I also understand that in some cases even after a hysterectomy some patients still report symptoms.

You’ve both worked on the stress-related Endometriosis studies. Thank you!! What other studies are you/have you worked on regarding Endometriosis?

With my background in gastrointestinal inflammation and recent evidence suggesting a potential beneficial impact of manipulating the intestinal microflora by administration of beneficial bacteria (probiotics) in some immune conditions we would like to study this in endometriosis.  Further we have carried out some preliminary studies which suggest the potential benefits of exercise in counteracting stress in our animal model so we are now pursuing this line of research in a more controlled way.

Do you plan on conducting human studies regarding the stress and Endometriosis relationship?

Through collaborations with Dr. Idhaliz Flores we hope to translate our animal studies to carry out interventions in patients focusing on how stress management can impact the severity of the symptoms and better the patients’ quality of life. Some patients with chronic conditions (other than endometriosis) have reported the possible beneficial effects of exercise and different coping mechanisms and we would like to explore this further.

Where do you see medical care and treatment headed for Endometriosis over the next 10-20 years?

I would like to see a ‘whole body’ approach for medical care and treatment for endometriosis patients where psychological, behavioral, and stress-reduction interventions as an integral part of a multidisciplinary clinical management plan that can be offered to patients.  This would involve a team of health professionals working together including the surgeon, immunologists, endocrinologists and nutritionist as well as those specialized inn pain management.  Hopefully also some of the cell signaling pathways which we are currently unraveling might yield some new more specific targets against which small molecules can be developed offering new drug treatments with fewer side effects than those currently available.

Any words of advice for Endometriosis sufferers who may be reading this?

Since I do not personally suffer from the condition I am a little hesitant to answer this since I cannot ever fully appreciate living with this. However, I think that, as with any other chronic disease where our understanding is still limited, it’s important to trust your instincts and ask for other opinions if you feel that your medical team is not providing you with options. Investigate ways of trying to cope with your symptoms through a more holistic approach and share your concerns with your family, friends or a support group.

What can we do to help you and the medical community?

I think that it is very important to continue to increase awareness of endometriosis so that both the general community and physicians carry out earlier investigations into the symptoms that a patient might have, and their possible underlying causes rather than dismissing pain as something to be expected as part of the monthly cycle. This can be critical in adolescents who might not understand what is going on and already be dealing with teenage hormonal changes.

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If you would like to follow Dr. Flores Caldera’s and Dr. Appleyard’s efforts in Puerto Rico, you may do so by the following:

Webpage: http://www.endometriosispr.net/

Facebook: Endometriosis Puerto Rico and EndoTeens Groups; Fundacion de Pacientes Puertorriqueñas con Endometriosis Fan Page

Twitter:  @endopr@2010

Also, if you would like to keep apprised of these Question and Answer sessions, you can follow them by clicking here.

I would like to personally thank Dr. Appleyard for taking the time to thoroughly review and respond to these questions, and for her ongoing efforts and research! Together, we can help spread awareness, education, and moral support.  We are not alone. We are a mighty force!

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