dermatology

Women on Women’s Health

By Kim Krieger

Photography by Tina Encarnacion

line art of woman doctor and patient

Women doctors were a rarity in the U.S. until just a few decades ago, and it wasn’t easy for a woman seeking a female obstetrician or general practitioner to find one. But times have changed — women surgeons, doctors, and health care practitioners of all sorts are everywhere.

At UConn Health, we’re proud to have an army of women caring for women in every specialty, as doctors, therapists, and nurses. Many have advanced degrees and research projects in addition to their clinical work.

We spoke to just a few of the many, many women who do research and provide clinical care for other women at UConn Health. We asked them why they do what they do, how caring for women is different than caring for men, and anything else they thought was important. This is what they said.


Gynecological Surgery

I need you to take it easy for just one week.

Dr. Danielle Luciano’s patients are usually younger women with pelvic pain or unmanageable periods related to uterine fibroids or endometriosis. Luciano tries medical treatments with the women first. If that doesn’t work, she offers minimally invasive surgery that solves the pain while sparing her patients’ fertility.

Dr. Danielle Luciano

Dr. Danielle Luciano cares for women throughout their lifespans.

“As an OB/GYN, I take care of my patients throughout their lifespan. I might remove their endometriosis when they are young,” and help them in menopause too. As a fellow woman, she can relate to her patients and perhaps give them more convincing advice than a male doctor might.

“I’ve had some babies, and I’ve had to have some things fixed afterwards, so I know where they’re coming from,” Luciano says. “I can say, ‘Look, I know you’re going to go home and try to do 1,000 things. But I need you to take it easy for just one week.’”

Fibroids and endometriosis affect a lot of women, around 10 percent. Oftentimes these conditions run in families, and a mom may normalize it when her daughter suffers, explaining the same thing happened to her. But if a woman has miserable periods with such heavy bleeding, terrible pain, or gastrointestinal symptoms that she can’t work or go to school, there could be something wrong that Luciano can help with.

Professions sometimes run in families, too. Luciano’s father, Dr. Anthony Luciano, is also an OB/GYN at UConn Health, specializing in reproductive endocrinology and minimally invasive surgery.

“Initially I didn’t want to do anything he did — but the more I learned, the more I wanted to have that skill and expertise,” Luciano says.

She and he now work together; he is a member of the Center of Excellence for Minimally Invasive Gynecologic Surgery at UConn Health. She is the director.

Breastfeeding

If lactation is a superpower, nursing is an art.

If lactation is like a superpower — a woman makes milk, and it’s perfectly nourishing, antibacterial, immunity-boosting, and always exactly the right temperature — then nursing is more of an art, a skill women learn by observation or instruction.

But fairly often in the U.S., women have trouble with it, and end up pumping or formula feeding even if they’d rather nurse.

“Whenever we talk about breastfeeding it becomes a very hot and emotional conversation,” UConn nurse-scientist Ruth Lucas, Ph.D., RN, says. She wants to cool that conversation off with data.

Lucas spent 20 years working as a nurse and lactation specialist, “supporting mom in whatever way she can feed her baby and feel good about herself.” But the more she saw, the more she wondered why for so many women breastfeeding just didn’t work. So she turned to research, and her first project has zeroed in on pain during nursing. Why does it happen, and how can we help women who want to nurse but find it agonizing?

She’s finishing up a pilot study that tracked women who initiated breastfeeding, their experiences, and their gene variants that might be linked with pain. And that’s just the start. She’s also interested in the baby side of the equation: different babies approach breastfeeding differently. Does this affect mom’s pain? Does the pain change the breastmilk? Does that affect the babies?

“We all want to grow and nurture our children,” Lucas says. She wants to nurture the women, too.

Pelvic Health

Cultural taboos prevent patients from admitting that they have issues.

Lauren Brennan and Cathy Trahiotis want you to talk to your patients about peeing. And sex. Also bowel movements. Like, how often does your patient poop?

“If they say ‘once a week,' you know there’s a problem,” Brennan says, laughing. She’s a family nurse practitioner who works in the urology practice at UConn Health. Trahiotis is a physical therapist who specializes in women’s pelvic health. And they’re on a mission to educate people — and alleviate people’s fears — about incontinence and other pelvic problems.

Recent studies have found that almost half of adult women experience either stress incontinence — involuntary urination when coughing or exercising — or urge incontinence, when they feel the urge to urinate but can’t get to a toilet in time.

“But it’s not normal to have incontinence! We can treat it,” says Trahiotis.

Dr. Cathy Trahiotis and Dr. Lauren Brennan

Cathy Trahiotis and Lauren Brennan want docs to talk to patients about peeing. And sex.

She notes that for some women, pregnancy can be the start of pelvic issues. The heavy, swelling uterus presses on nerves in the pelvis, stretches ligaments, and separates the abdominal muscles (a condition called diastasis recti). After birth, if the abdominals don’t knit back together, it leads to weakness that can force the pelvic muscles to compensate, stressing them and potentially causing pubic pain or incontinence.

Fortunately diastasis recti can usually be cured with physical therapy. Other issues involving the pelvic muscles can be similarly healed through specific exercise, stretching, and diet.

In her urology practice, Brennan often sees patients with dyspareunia, or painful sex. It can often be treated. But it’s almost never the reason the patient made the appointment, Brennan notes. She always has to ask.

Both Brennan and Trahiotis say cultural taboos against discussing bodily functions prevent patients from admitting to their doctor that they have issues. So doctors should bring it up first. Ask patients directly: “How’s sex for you? Is it comfortable? Do you have any issues you’d like to talk about?” Ask about peeing and bowel movements. Or if your patients are super shy about discussing it, perhaps a written questionnaire would be better.

No matter how you do it, Trahiotis and Brennan say, the bottom line is “know about it, talk about it, don’t be afraid! And fix it without surgery!”

Dermatology

Sometimes she’ll point out something I can’t see. That’s when I reassure her.

The trick to drawing out a patient’s concerns about her skin is to hand her a mirror, says UConn Health dermatologist Dr. Mona Shahriari.
“Sometimes she’ll point out something I can’t see. That’s when I reassure her. I’m a trained dermatologist, and if I can’t see it, the world probably can’t, either.”

Dr. Mona Shahriari

Dr. Mona Shahriari wants women to feel like at least once, they're being taken care of.

Shahriari has seen a lot. The year before she entered medical school, she volunteered to work with individuals exposed to radiation and chemicals during the Iran-Iraq War. They had a tendency to grow bizarre forms of skin cancer. Many of them would try to hide the growth and ignore it. And now, even though she’s practicing medicine on the other side of the planet with an entirely different population, some of her female patients have a similar problem.

“They’re so busy caring for their families they forget to care for themselves. Women often show up with undiagnosed skin diseases” they’ve been ignoring, says Shariari. When they finally do make it to her office, she gives them the time they need. Most of the time her women patients come to her with concerns about skin cancer, but there’s usually another underlying worry: aging.

“Society makes women very self-conscious about their appearance,” says Shahriari. And their skin is readily visible to the world. So she listens, and helps them. Ultimately, a patient may need bloodwork, a biopsy, laser treatment, or reassurance. But no matter what, “I make them feel like at least once, they’re being taking care of. Their concerns are the priority.”

Gynecologic Oncology

Some women say “I just can’t do this anymore.” But we have lots of options to help.

The patients keep her going. Many of the women are overweight. A lot of them have diabetes and high blood pressure. They don’t heal well; they’re greater surgical risks; they’re medically fragile. And yet, they keep going. And so does she.

“I love my patients,” says gynecologic oncologist Dr. Molly Brewer, chair of UConn Health’s Department of Obstetrics and Gynecology. “They endure so many incredibly hard treatments. They’re an inspiration.”

Dr. Molly Brewer

Dr. Molly Brewer says getting cancer patients healthy and back to their lives makes the challenges of her job worth it.

Typically, the women are referred to her by primary care physicians, gynecologists, or emergency room doctors when the women show up with a suspicious lump in their abdomen, cervix, or vulva. Such patients are usually urgent, and Brewer always gets them into her office within a week or less. If they don’t have cancer, she sends them back to their regular doctor. But if they do have cancer, she cares for them from the beginning to the end, performing surgery to remove the mass, treating it with anti-cancer drugs, and helping them through into remission. She also cares for certain breast cancer patients who suffer from unique gynecological issues. Certain drugs used to prevent a recurrence of the cancer can cause vaginal atrophy because they suppress estrogen, for example.

“Vaginal atrophy makes sex really painful. Some women say ‘I just can’t do this anymore.’ But we have lots of options” to help, Brewer says.

Her research centers on ovarian cancer and new technologies to diagnose it. She and her partner, newly arrived gynecologic oncologist Dr. Bradford Whitcomb*, are currently enrolling patients for an ovarian cancer vaccine study.

She chose gynecologic oncology because she loves it, and she loves it because of the patients. The challenge of taking care of women with difficult cancers, and the inspiration of watching them make
it through.

“When we get them into remission, they’re healthier, they feel better, they’re able to go back to their life. And that makes it all worth it.”

Lab Notes – Summer 2017

Melanoma’s Signature

illustration of a melanoma cell

Dangerous melanomas likely to metastasize have a distinctive molecular signature, UConn Health researchers reported in the February issue of Laboratory Investigation. Melanomas are traditionally rated on their thickness; very thin cancers can be surgically excised and require no further treatment, while thick ones are deemed invasive and require additional therapies. But melanomas of intermediate thickness are harder to judge. The researchers measured micro-RNAs produced by melanoma cells and compared them with the micro-RNAs in healthy skin. Micro-RNAs regulate protein expression in cells. The team found that melanomas with the worst outcomes produced lots of micro-RNA21 compared to melanomas of similar thickness with better outcomes. In the future this molecular signature could help dermatologists decide how aggressively to treat borderline melanomas.


Chili Pepper and Marijuana Calm the Gut

The medical benefits of marijuana are much debated, but what about those of chili peppers? It turns out that when eaten, both interact with the same receptor in our stomachs, according to UConn Health research published in the April 24 issue of Proceedings of the National Academy of Sciences. The scientists found feeding mice chili peppers meant less gut inflammation and cured those with Type 1 diabetes. Why? The chemical capsaicin in the peppers bonds to a receptor found in cells throughout the gastrointestinal tract, causing the cells to make anandamide — a compound chemically akin to the cannabinoids in marijuana. The research could lead to new therapies for diabetes and colitis and opens up intriguing questions about the relationship between the immune system, the gut, and the brain.

illustration of chili peppers and marijuana in the gut


Isolating Their Target

brain scan

Brain cells of individuals with Angelman syndrome fail to mature, disrupting the ability of the cells to form proper synaptic connections and causing a cascade of other developmental deficits that result in the rare neurogenetic disorder, according to UConn Health research. Neuroscientist Eric Levine’s team used stem cells derived from Angelman patients to identify the disorder’s underlying neuronal defects, an important step in the ongoing search for potential treatments and a possible cure. Previously, scientists had relied primarily on mouse models that mimic the disorder. The findings were published in the April 24 issue of Nature Communications. While Levine’s team investigates the physiology behind the disorder, UConn developmental geneticist Stormy Chamberlain’s team researches the genetic mechanisms that cause Angelman.


The Cornea’s Blindness Defense

eye

The formation of tumors in the eye can cause blindness. But for some reason our corneas have a natural ability to prevent that from happening. Led by Royce Mohan, UConn Health neuroscientists believe they have found the reason, findings that will be detailed in September’s Journal of Neuroscience Research. They link the tumor resistance to a pair of catalytic enzymes called extracellular signal-regulated kinases 1 and 2. When ERK1/2 are overactivated in a specific type of cell, the “anti-cancer privilege of the cornea’s supportive tissue can be overcome,” says Mohan. That happens in the rare disease neurofibromatosis-1. “These findings may inform research toward developing better strategies for the prevention of corneal neurofibromas,” says Dr. George McKie, cornea program director at the National Eye Institute, which funded the study.

Finding Skin Cancer in a Flash

Dr. Jane Grant-Kels and Jody D’Antonio, CMA, center, examine a high-resolution, cellular image of a patient’s skin using a technology called In Vivo Reflectance Confocal Microscopy.

Dr. Jane Grant-Kels, right, and Jody D’Antonio, CMA, center, examine a high-resolution, cellular image of a patient’s skin using a technology called In Vivo Reflectance Confocal Microscopy.


New technology at UConn Health has practically eliminated both unnecessary biopsies and human error in skin checks at the dermatologist’s office.

UConn Health is the only institution in Connecticut to offer the latest smart technology to hunt for skin cancer and keep an eye on changing moles. The integrated body-scanning camera and smart software technology, called FotoFinder Bodystudio Automated Total Body Mapping, “helps us find skin cancer in a flash,” says Dr. Jane Grant-Kels, professor and vice chair of UConn Health’s Department of Dermatology and director of the UConn Cutaneous Oncology Center and Melanoma Program.

FotoFinder allows dermatologists or staff to take 20 or more photos of a patient’s entire body, including the palms and the soles of the feet, in about 10 minutes. It also allows easy comparison of photographs year after year, and alerts the dermatologist to changes or new growths.

UConn Health is the only institution in Connecticut to offer the latest smart skin-mapping technology.

“This technology is going to help us save more lives from skin cancer and melanoma,” says Grant-Kels. “It allows for early detection and a more exact science of monitoring patients’ skin changes.”

If concerning growths are detected, another recently arrived technology called In Vivo Reflectance Confocal Microscopy uses a non-invasive optical imaging technique that provides a high-resolution cellular image of the skin. This new technology is safe and painless, and in many cases can be used in lieu of a painful skin biopsy.

“FotoFinder coupled with Confocal will help us go a long way to reducing the number of biopsies performed, including unnecessary biopsies of non-cancerous skin growths,” Grant-Kels says.

For baseline and follow-up photo sessions using the FotoFinder technology, a patient will be asked to get into the proper positions guided by a red laser light and a specially designed floor mat that ensures proper foot positioning. FotoFinder’s smart body-scanning camera automatically moves into various positions to take photos of the entire body, and the software module rapidly stitches the photos together for the dermatologist to review.

After the patient’s follow-up photo session, within seconds the technology precisely places the most recent skin images atop the baseline photos. The software seamlessly aligns and analyzes the new and old photos, and then circles all the detected new and visibly changed skin lesions and moles.

This technology is going to help us save more lives from skin cancer and melanoma.

White circles around lesions or moles signal to the dermatologist no change; yellow circles signal caution to the doctor, as the lesion or mole has changed since the last visit; and red circles raise alarm for the doctor, as a new lesion or mole growth has been identified. This allows the dermatologist to investigate the most alarming skin lesions first.

The technology also allows dermatologists to compare lesion or mole photos side-by-side and to quickly zoom from 20x up to 70x magnification to examine suspicious areas in high-resolution and determine which spots to examine more closely with the traditional handheld dermoscopy tool. The system also includes high-tech, handheld electronic dermoscopy with a built-in medicam for even closer examination and additional photo captures. Plus, the machine is mobile and can be moved easily among exam rooms.

The Doctors Are In – Spring 2016

UConn Health welcomes the following new physicians:


Seth Brown, MD

Specialties: Ear, Nose, and Throat/Otolaryngology, Otolaryngology Surgery
Location: Farmington


Saira Cherian, DO

Specialties: Internal Medicine, Primary Care
Locations: Farmington


Alexis Cordiano, MD

Specialty: Emergency Medicine
Location: Farmington


Montgomery Douglas, MD

UConn School of Medicine Chair
of Family Medicine

Specialty: Family Medicine
Location: Farmington


Jeffrey Indes, MD

Chief of the Division of Vascular and Endovascular Surgery

Specialty: Vascular Surgery
Location: Farmington


Leah Kaye, MD

Specialty: Obstetrics and Gynecology
Location: Farmington


Glenn Konopaske, MD

Specialty: Psychiatry
Location: Farmington


Guoyang Luo, MD

Specialties: Obstetrics and Gynecology, Maternal-Fetal Medicine
Location: Farmington


Jose Montes-Rivera, MD

Specialties: Neurology, Epilepsy
Location: Farmington


Rafael Pacheco, MD

Specialty: Radiology
Location: Farmington


Mario Perez, MD, MPH

Specialties: Critical Care, Internal Medicine, Pulmonary Medicine
Location: Farmington


Edward Perry, MD

Specialty: Hematology/Oncology
Location: Farmington


Surita Rao, MD

Specialties: Addiction Psychiatry, Psychiatry
Location: Farmington


Belachew Tessema, MD

Specialties: Ear, Nose, and Throat/Otolaryngology, Otolaryngology Surgery
Location: Farmington


Cristina Sánchez-Torres, MD

Specialties: Child and Adolescent Psychiatry, Psychiatry
Locations: Farmington, West Hartford


Brian Schweinsburg, Ph.D.

Specialties: Child and Adolescent Psychiatry, Psychology
Locations: Farmington, West Hartford


Mona Shahriari, MD

Specialties: Dermatology, Pediatric Dermatology
Locations: Canton, Farmington


Kipp Van Meter, DO

Specialties: Family Medicine, Internal Medicine, Primary Care
Location: Canton