MGH Wellman Center physicians bring treatment to Armenia

By | March 8, 2020

Mary Aloyan, 14, from the village of Gyumri, 160 miles from Yerevan, is about 90 percent through the treatment for port-wine stain on her face. She said the laser procedures can be painful, but not intolerably so, and her parents said the results have been worth it.

“As my child was growing, she was feeling unconfident and ashamed. We decided to apply for laser treatment,” said A. Aloyan, Mary’s father. “We haven’t finished treatment yet, but the results are obvious, and we plan to continue the interventions until my daughter will have a port-wine-stain-free face. My child is more confident and does not concentrate on the port-wine stain on her face. We are happy.”

Aloyan said he’d definitely recommend the treatment for others, as it improves the quality of life for patients and their families.

“As a parent, it’s hard when your daughter goes through all of this, but the results are encouraging,” Aloyan said.

Garibyan is no stranger to family sacrifice. Her parents left Armenia for Glendale, Calif., fearing that her younger brother would be pressed into service amid their nation’s widening war with Azerbaijan. They choose Glendale because of its large Armenian community.

Garibyan arrived at Los Angeles International Airport speaking not a word of English, and she still recalls the confusion and dislocation of her first months in America — especially in the classroom — as she wrestled with a new language. Garibyan’s mother thought their stay would be brief, but months became years, laden with cultural and financial challenges. As Garibyan’s English improved, so did her grades. Against the advice of a high school guidance counselor who thought community college was her best bet, Garibyan applied to the University of California, Los Angeles, and was admitted. She studied science and spent a consequential summer at the University of California at San Francisco lab of Donald Ganem, a Harvard Medical School alumnus who urged her to apply to Harvard’s M.D./Ph.D. program.

Garibyan graduated with a doctorate from Harvard’s Biological and Biomedical Sciences program in 2007, and then earned her M.D. from HMS in 2009. After her residency in dermatology, Garibyan encountered a high school friend, Ray Jalian, who was working as a fellow with Anderson at MGH’s Wellman Center. Drawn by the promise of conducting translational research that could have a direct impact on patients’ lives, Garibyan joined the lab. Now she’s conducting studies on an injectable coolant that she and her team invented and developed in the lab. They intend to use this for removing disease-causing fat tissue in the body and for treating pain. This coolant is able to reduce pain by numbing nerves without resorting to the extreme cold typically used in cryotherapy. Garibyan hopes her discovery will reduce or eliminate the need for opioids to treat pain, thus helping fight the deadly epidemic of drug abuse ravaging the nation.

The Armenia program grew out of Anderson’s earlier efforts in Vietnam, where he and colleagues performed laser surgery for the same vascular problems as in the Armenia program. Garibyan met an Armenian plastic surgeon who was visiting Boston University and who’d spent some time at Anderson’s lab. After seeing their work, he urged them to bring their expertise with laser surgery for vascular abnormalities to Armenia.

“Rox said, ‘OK, let’s go,’” Garibyan said. “I was like, ‘What? I have to ask my boss.’ He said, ‘I am your boss.’ So I said, ‘Yes, we should go.’”

That first trip, in 2013, coincided with a plastic surgery conference in the capital, and included Garibyan, Anderson, and Jalian. They brought a borrowed laser and focused on treating scars, port-wine stains, and hemangiomas.

“The first day we saw over 70 consultations. There were so many people wanting to be seen for scars and vascular anomalies,” Garibyan said. “We had to use our creativity and imagination. We were only given the dentist’s room to work out of, so we divided the room into three sections: pre-op, treatment, and post-op.”

In addition to consulting with patients and treating those they could, they also taught local physicians to use the lasers and gave lectures at the plastic surgery conference.

“I was really happy because I had now created something where I could meaningfully give back,” Garibyan said. “We decided that we will do this every year, and we could make it into the same program that the Vietnam project had become.”

The program benefited early on from the involvement of California dermatologist Christine Avakoff and her husband, physician John Poochigian, who have traveled regularly to Armenia since 2000. It was Avakoff who introduced Garibyan to the Armenian American Wellness Center, which, along with Arabkir Hospital, has become one of the collaboration’s primary sites in Armenia. Avakoff, who was retiring, donated the first laser to the center — six have been donated so far, with the major donors being the Candela and Quanta laser companies. Garibyan also worked with Avakoff and Poochigian to establish Face of Angel to support the work there.

Avakoff and Poochigian are of Armenian ancestry and were struck on their travels by the number of people with visible vascular abnormalities that are relatively easily treated in the U.S. Avakoff said she recalled one boy who had a port-wine stain on his feet, which bled when he walked. Others had gone blind because the condition had been untreated, while still others had suffered disfiguring surgeries using 1970s-era lasers, Avakoff said.

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“There were people who felt that they couldn’t work or face anybody with this problem. It’s a real social concern,” Avakoff said. “One of them found out I was the one who sent the laser, and she started crying. It was such an easy thing. You do these treatments, and the results are so amazing.”

While Garibyan is planning a trip with several colleagues to Yerevan this spring, word is spreading about the program and its predecessor in Vietnam. Avakoff said the program has begun to draw patients from neighboring countries, including Russia. A lawmaker in Montenegro heard about the program through one of the participating physicians and asked whether they’d bring it there.

“We might go there for a few days on the way back from Armenia, do an assessment, and see what they need,” Garibyan said.

Health & Medicine – Harvard Gazette