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!

Meet Dr. Idhaliz Flores Caldera

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Idhaliz Flores Caldera, Ph.D.

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 Caldera have agreed to answer some questions I’ve posed to them.  Both doctors are incredibly busy; however, have still managed the time to answer these questions!

Q&A Session with Idhaliz Flores Caldera, Ph.D.

Do you have Endometriosis?

Yes, I have laparoscopically confirmed endometriosis. It also runs in my family – my two sisters have endo too.

If so, do you mind sharing a bit of your own story and journey?  If not, what got you interested in studying Endometriosis?

I was diagnosed with Endo at 28 y/o, although I had painful periods all my life, and suffered from several sudden bouts of severe pain episodes that required emergency hospitalization, but no one knew the cause. After my diagnosis, I suffered 8 years of infertility due to Endo. I have tried all available treatments and have undergone 4 surgeries, but the disease kept progressing. As a molecular biologist I started wondering what was the cause of Endo, whether there was research about molecular mechanisms underlying this disease, but I noticed that back in 1994 there was very little research done on Endo. I decided to apply my knowledge and expertise to understanding my own condition. I applied for and obtained NIH funding to study the epidemiology, molecular biology and genetics of Endo. I have conducted research on Endo non-stop since 2001.  I have been fortunate to have collaborators from other fields (physiology, neuroscience, genetics, pathology, statistics, psychology and public health specialists) who have joined me in these efforts. We have now over 10 publications in the field and more coming, and close to a hundred presentations at national and international scientific meetings, including the World Congress on Endometriosis.

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

I have been interested in identifying the genetic factors involved in endometriosis (we showed that there is a genetic component in chromosome 10 associated to endo in the Puerto Rican population).

Also, I have researched the molecular mechanisms that could explain the attachment, survival and growth of ectopic endometrium that would lead to lesions (Sampson’s theory).

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

I can’t provide hard facts on this since our research is not focused in this area.  However, there are some reports in the literature supporting a beneficial role of high vegetable/low fat diet, of omega-3 supplements and also of certain vitamins (not as supplements but directly from food sources –  look for studies by Missmer et al – for endometriosis symptoms.  Anecdotically I have heard patients state that changes in diet have helped with symptoms.

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

I can’t comment since this is a very clinical question beyond the scope of my expertise. However, I have heard reports of women who continue suffering from symptoms after the hysterectomy. In addition, it is important to note that pelvic pain can be due to many other causes which need to be ruled out.

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

We have researched the genetic basis of endometriosis, the discovery of non-invasive (blood, serum) diagnostic biomarkers for endometriosis and potential new targets for therapy using cell lines and animal models. We have also researched the impact of endo symptoms on quality of life, work productivity and health insurance costs.

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

We are very interested in continuing our research on the effects of stress on endometriosis in human subjects. It is important to confirm our findings using the animal model in humans. I would be very interested in testing how stress management can influence the symptoms and the quality of life of patients. Also, to explore what coping mechanisms are most effective to deal with symptoms and improve quality of life.

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

I would like to see centers of expertise in each country, where patients can be managed through a multidisciplinary team of experts that include not only medical professionals (gynecologists and other related specialties such as reproductive endocrinologists), gastroenterologists, urologists, physiatrists and pain management specialists, but also allied health, psychologists, nutritionists and which incorporate stress management techniques.

I would like to see more research on non-hormonal, targeted treatments for endometriosis that have less side effects and do not preclude women of keep trying to get pregnant if they so desire. I think there is a lot more to be done with immune-based therapies, and with small molecules that specifically target cell signaling mechanisms shown to be aberrantly regulated in endometriosis. There is a lot to learn and take from the cancer research field, as endometriosis and cancer share many of the same molecular pathways.

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

Don’t take your symptoms lightly – they are a matter of concern; seek for different alternatives to alleviate pain and/or infertility. Don’t be afraid to ask questions and to get second or third opinions.

Document your symptoms; learn what helps, what makes them worse. Seek other specialists and alternative medicine approaches. Make relevant changes in lifestyle that will improve health overall and the symptoms of endometriosis also, including eating a healthy diet, maintaining a healthy weight, doing exercise and getting sufficient rest and sleep, and finally engaging in activities to manage their stress, whatever they may be. And speak up, educate others (especially teens), & volunteer in patient-based organizations. Everyone can help to raise awareness.

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

Increase awareness of endometriosis as a real disease that requires a multi-faceted, long-term and personalized approach for management. To the medical community and the general community, to understand that if you don’t see the pain doesn’t mean it isn’t there; to be empathetic to women suffering from a disease with no cure and limited effective symptom management approaches. To the employers and co-workers, to start a conversation with women with endometriosis who are co-workers to understand their disease and provide avenues to improve their productivity at work during their good days while ensuring they receive appropriate treatment.

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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 will update them as regularly as I receive any further feedback from Drs. Appleyard and Flores Caldera.

I would like to personally thank Dr. Flores Caldera for taking the time to thoroughly review and respond to these questions.  And for sharing her personal struggle with Endometriosis with us! Together, we can help spread awareness, education, and moral support.  We are not alone. We are a mighty force!

Meet Dr. Caroline Appleyard

CBA
Caroline B. Appleyard, Ph.D.

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.  The answers will trickle in as time allows, and rather wait for the entire Q&A session (which could be several weeks or months), I’ve decided to post what I receive, as I receive it. Here goes:

Q&A Session with Dr. Caroline Appleyard

Tell me a little bit about yourself.

Throughout my undergraduate, graduate and post-graduate education in Britain, Canada and the United States there was one common denominator – a lack of female role models. I have never been taught by a woman but this never stopped me from pursuing a career in science.

When I was in school I read a lot and wanted to know how things ‘worked’. I loved to make projects and design things and really enjoyed doing ‘hands-on’ type activities.  I loved all my science classes at school and wanted to become an astronaut but unfortunately I had very bad eye-sight.  My mother was a nurse but although I was interested in how our bodies work and what happens when things go wrong I wasn’t interested in becoming a physician.  Since I loved both biology and chemistry I decided to study Physiology and Pharmacology at the University of Edinburgh and that’s when I first became involved in laboratory research.  I carried out my undergraduate research project in the National Blood Blank in Edinburgh, Scotland studying purification of a coagulation factor. With this experience I wanted to understand more about how inflammation causes diseases so undertook my graduate studies at the University of Southampton in England where I carried out my experiments in tissues from patients with inflammation of the digestive tract (colitis). I received a Wellcome Trust Travel Award to train as a post-doctoral fellow in the Gastrointestinal Research Group at the University of Calgary, and followed this with a second post-doctoral fellowship at the University of South Dakota.

I moved to Puerto Rico in 1998 to set up my Gastrointestinal Research Laboratory at Ponce School of Medicine and Health Sciences in the southern part of the island. My laboratory is interested in the pathophysiological basis and consequences of inflammation within the gastrointestinal tract. We want to answer questions such as why inflammation can turn into cancer, how stress can affect the intestines, and how do the bacteria in the intestinal tract affect its function?  We have several projects underway to try to elucidate the factors contributing to Inflammatory Bowel Disease, colitis-associated colorectal cancer, Irritable Bowel Syndrome and intestinal endometriosis. These chronic gastrointestinal disorders are characterized by abdominal pain, inflammation and alterations of bowel motility.  Our laboratory uses a variety of different experimental techniques, at the whole organ, cellular and molecular level.

At my minority–serving institution I am responsible for overseeing professional development workshops, research seminars, laboratory training experiences, mentoring teams and program evaluation, as Program Director for a federally sponsored graduate training program and the Co-Leader of the Training/Career Development Core for our Cancer Center Partnership with the Moffitt Cancer Center in Florida. I have personally trained and mentored over 80 students (undergraduate, master’s, and doctoral) in my laboratory. I have a great deal of interest in helping the next generation of scientists develop, and hope to offer a positive female role model, so that all students interested in science can fulfill their potential. As a long-time member of the American Physiological Society (Women in Physiology Committee 2010-2013) and the current President of the Puerto Rico Physiological Society, I have helped organize several outreach activities at the high school level.

I feel that my unique experience and viewpoints, having been exposed to different cultures, gives me a strong understanding of the ‘obstacles’ that women and minorities still face in science. I have also dealt with the challenges of balancing a young family with work and hobbies (my own favorites are scuba-diving, running and skiing), and I look forward to offering what advice I can to others.

Do you have Endometriosis?

No.

If not, what got you interested in studying Endometriosis?

My background is in inflammation of the intestinal tract which I have been studying since I was in graduate school, specifically focused towards Inflammatory Bowel Disease (or colitis).  When I started working at Ponce School of Medicine (officially now called Ponce Health Sciences University) through informal discussions with one of my colleagues, Dr. Idhaliz Flores, we began to recognize that there appeared to be many similarities in the immunopathology between colitis and endometriosis.

This led to us proposing a project studying the similarities and differences in the involvement of an inflammatory mediator and its receptor (tumor necrosis factor alpha) in the two conditions. We used molecular profiling to validate the use of our models in an effort to identify novel therapeutic and diagnostic targets. Around the same time I was becoming increasingly interested in the area of neurogastroenterology, since stress is known to impact the pathophysiology of colitis, and my laboratory had some ongoing projects looking at the effects of stress on inflammation in colitis and irritable bowel syndrome. We were also fortunate to have some colleagues working in my department who are neuroscientists by training. A natural extension of this was then to extend these studies into endometriosis.

What has been very enlightening for me during these past years is how many women, and younger girls, suffer from this condition, many without knowing about it for several years.  My hope is that raising awareness of the impact of stress on chronic pain conditions such as endometriosis, highlights the potential for the use of complementary therapies working alongside standard medicines to help empower the patients.

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I want to thank Dr. Appleyard for taking the time to answer these questions, and look forward to receiving more in the future (and sharing them with you!).  And keep up the great work!!

Q&A Interview Pending

Q&A

Interviews of Dr. Appleyard and Dr. Flores (two leading Endometriosis researchers in Puerto Rico) are in the works!  They were two of the investigating team for the stress studies referenced in my recent blog, here.

Each has graciously agreed to sit down with me (virtually) and answer some questions about Endometriosis! I’m so very excited for this opportunity! But I want to share this opportunity with YOU!  If you have any questions you would like me to include, please leave your questions in the Comments below! I plan on submitting my questions by the end of this week.

Yours, Lisa