Top Doctors for Women

Okay, ladies. If there’s one lesson to be learned on the next few pages, it’s the importance of taking charge. Enough with putting off that doctor’s visit or thinking it’s too late to ditch bad habits. We hope the stories of how five women trumped recent health scares will inspire you to treat your body well, whether it’s overcoming the fear of bad news or finding the motivation to live your best life. (If you won’t listen to us, listen to Oprah.) Here's to all of Rhode Island's incredible physicians and to the women below, who remind us that being a good patient is as important as having a great doctor.



Ready to Exhale
After a surprising health scare and a cutting-edge surgery, Barbara Bishop is grateful to the family, friends and doctors who helped her through.

“I never felt so sick,” says Barbara Bishop. The fifty-two-year-old mother of three had always kept fit and rarely fell ill when she suddenly was sidelined with pneumonia in both lungs at the end of last summer. She hadn’t fully recovered when she went for an x-ray four weeks later, so neither she nor her primary care doctor, Kristin Poshkus, were too concerned that the x-ray came back as abnormal. “She said it wasn’t uncommon and to come back for another x-ray in four more weeks,” says Barbara. A month later, Barbara was back to her regular routine of walking four and half miles, five days a week. She was surprised when Poshkus called to say her latest x-ray still didn’t look right and sent her for a CAT scan.
“I was sure everything was fine,” says Barbara, a nonsmoker and former runner. “I felt great.” But she received unexpected news: The scan showed increased markings on her lower left lung. “My doctor said she wanted to send me to a cardio-thoracic surgeon, who would be the best person to determine what was wrong,” Barbara recalls. “That definitely made me a little anxious.”

Kristin Poshkus, M.D.

Poshkus scheduled a visit to Laurie Reeder at Kent Hospital, who has the distinction of being the only female thoracic surgeon in Rhode Island. “The minute my husband and I walked into the office, we felt comfortable,” says Barbara. “She’s sweet, she’s lovely, she’s full of energy — and she said to me, ‘I know what it is.’ ”

 The markings turned out to be a mass of  lung tissue with abnormal blood vessels, a very rare condition known as pulmonary sequestration, which shows up in infants and young children as repeated pneumonia. “Barbara never had anything like that, just this one episode,” marvels Reeder. “She’s very physically fit and active, which is what made it so shocking.” The condition is risky. “It can create long-term blood pressure issues and heart strain from pumping extra blood to the wrong place,” says Reeder. “That portion of the lung doesn’t exchange oxygen normally, so it is prone to recurring infections.”

Barbara, who had never been in the hospital except for the birth of her daughters, found herself facing a surgical cure. “It seems pretty drastic, but the treatment is to cut out that part of the lung,” says Reeder. Typically, the procedure involves making an incision that wraps from the chest to the back and splitting open the rib cage. However, a relatively new technique known as video-assisted thoracic (VAT) surgery offered the possibility of a minimally invasive procedure. “A camera allows you to see inside so you don’t have to open everything up,” says Reeder. “It’s not always an option, but I like to use this approach whenever I can. Recovery is dramatically better — faster, less painful.”

Barbara Bishop

Prior to operation day, Barbara made a conscious effort not to let fear get the better of her. “Every once in a while a ‘what if’ thought sneaks into your head, but I just thought, ‘I’m not going to go there. I’m going to stay positive,’” she says. She also had a strong support system to back her up: “My husband and I have very strong faith. We had so much support from our daughters and family and friends and our church. It was overwhelming, in a good way. I felt very fortunate.”

The technical challenge of VAT surgery means it can be long. (“Everyone in the waiting room had the hardest job,” Bar-bara says.) Rest and a gradual return to exercise helped along her recovery; in six weeks, she was back to her daily walks. With half her left lung left, she can feel a difference when she takes a deep breath, but in time, says Reeder, the lung will 
fully adjust to pick up the slack. “Because Barbara never smoked and exercises regularly, the lungs should return to close to their normal capacity within a year,” she says.

Barbara’s experience underscores the importance of following up on appointments — she and Poshkus took her x-rays seriously even though she felt fully recovered from pneumonia. “No one wants to hear bad news, but being proactive about it has got to be better than walking around afraid to see a doctor,” Barbara says. “We don’t know if it was my lung that caused the pneumonia or if the pneumonia was just a coincidence that clued us in, but it was a blessing in disguise.”

 


 

Barbara Roberts, M.D.

 I Heart Fish
After two health scares caused by thirty years of high blood pressure and high cholesterol, Barbara MacDonald changed her ways, thanks to a top cardiologist, a supportive husband and lots of seafood.

There’s something about the simple directness in Dr. Barbara Roberts’ voice when she says, “If it walks, try not to eat it” that can turn a lifelong meat-eater into an instant seafood vegetarian. “She’s like Sister Superior,” says Barbara MacDonald, cheerfully describing the cardiologist who inspired her to change her life at sixty-nine years old. “She sets the ground rules and I follow.”

Barbara was in her mid-thirties when she first began having trouble with high blood pressure and high cholesterol (“That’s a good long time,” she says), relying mostly on medication to keep her healthy throughout the years. But six years ago, her gynecologist became concerned that her blood pressure wasn’t being properly managed. He phoned Roberts, director of the Women’s Cardiac Center at The Miriam Hospital, to ask if she would take on Barbara as a patient.

Adjustments to her medications and a lifestyle overhaul were the first order of business — Barbara had to quit smoking, exercise and follow a seafood vegetarian diet. “I think I scared her,” says Roberts. “I tell my patients, you may get away with breaking the laws of man, but if you break the laws of nature, you will always pay. The only question is when.”

Barbara’s “when” came two years later: Roberts heard bruits in one of her arteries during a check-up. “They’re abnormal sounds made when there is a build-up of plaque narrowing the artery,” Roberts says. A series of tests showed an increasing blockage in Barbara’s neck, even though she experienced no dizziness or symptoms. Roberts sent her to thoracic and vascular surgeon Dr. James Fingleton, who performed a carotid endarterectomy to clear the artery. “I was a nervous wreck at first,” says Barbara, recalling the days leading up to the surgery. “There’s always that fear of the unknown, but you have to overcome it. I had confidence in my doctors.”

The surgery was successful, but Barbara got a second scare last year after she started feeling “heaviness” in her legs during walks with friends. “I was having trouble keeping up,” she says. “I kept stopping to ‘gaze at the scenery’ because I didn’t want to say my legs were bothering me.” She joined the Y: “I thought it was old age and that I was just getting out of shape.” Howevever, when she went in for her annual carotid check-up that fall, the technician noticed her blood pressure was skyrocketing and sent her directly to Roberts’ office. “We were worried she had developed a blockage in an artery to the kidney,” says Roberts. “We took an MRA. It showed significant blockages in the arteries to her legs, which was causing the pain she got in her calves when she walked.” This time, Barbara didn’t require surgery — Dr. Immad Sadiq, an interventional cardiologist at Miriam, performed an angioplasty, inserting a catheter through the skin to dilate the arteries and implant stents. “The stents look like mesh tubes,” says Roberts. “They’re like scaffolding that keeps the artery from closing.”

Barbara McDonald

Within weeks, Barbara felt well enough to go with her husband on their yearly trip to Florida. “These doctors deserve so much credit,” she says. “I have so much confidence in Dr. Roberts because she has that confidence in herself. You can see she isn’t trying to guess or beat around the bush — she’s straightforward and honest.”

After more than thirty-five years as a cardiologist, Roberts knows it isn’t always easy to convince people to treat their bodies well, even though so much of the illness she sees is within her patients’ control. “Atherosclerotic cardiovascular disease is about 80 percent preventable. Of all the risk factors, there are only two you can’t change: age and family history,” says Roberts. “Smoking, obesity, sedentary lifestyle, abnormal blood cholesterol, high blood pressure, diabetes…all completely preventable, treatable or avoidable.”

Should Barbara ever be tempted to revert to her old ways, she has a secret weapon to keep her on track: her husband, a shellfisherman who keeps her supplied with plenty of fresh seafood for her heart-healthy diet. “I can do quahogs anyway you want them,” says Barbara. “Baked, grilled, sauteed…luckily, I enjoy fish.” 

 

Gut Instincts
Kristine Kelaghan downplayed her stomach pains, afraid she was over-reacting to the normal symptoms of pregnancy. One healthy baby girl 
later, she now knows to trust her intuition.

Round-the-clock sickness, pains in her abdomen, back aches, low-grade fevers…twenty-eight-year-old Kristine Kelaghan had been told these were common side effects of pregnancy. Still, she mentioned them to her obstetrician, who scheduled her for an ultrasound the following week to check for gallstones.

That weekend, after a spasm so severe it caused her to scream out in pain (“I scared my poor dog”), Kristine was reluctant to make a fuss. “My husband tried to get me to go to the hospital,” she says. “But I was afraid they were going to tell me to toughen up.” Since she had an appointment scheduled for Monday, she suffered out the rest of the weekend.

Silvia Degli-Esposti, M.D.

On Monday, her concern grew when the light pressure on her stomach during the ultrasound was excruciating. “Everything on the ultrasound showed there was nothing wrong,” Kristine says. “They thought maybe I wasn’t getting enough fiber in my diet.” Her doctor put her on bed rest and scheduled a visit to Dr. Silvia Degli-Esposti, director of the Center for Women’s Gastrointestinal Services at Women & Infants, who found her answer: Crohn’s disease, an inflammatory disease that attacks the gastrointestinal tract. It had caused a perforation in her small intestine, which explained her pain. With Kristine twenty-weeks pregnant, surgery was risky. “After a discussion with the other doctors, we decided to treat it conservatively with medication,” says 
Degli-Esposti — but this too she approached with great caution. “A lot of the medications typically required to treat the condition still have little or no studies to show how dangerous they are for the baby,” she says. (Kristine is participating in two studies to provide information about her treatment.)

Back at home, Kristine took it easy, following orders to leave the house for no more than an hour a day. “Things were going well,” she says, until she decided to spend one of her allotted hours shopping for a friend’s baby shower gift. “Let’s just say Babies ‘R’ Us with a pregnant person turns into a little more than an hour,” says Kristine. She woke up in the middle of the night with stomach pain and a high fever. She called Degli-Esposti, who met her immediately at the emergency room.

With septic shock a possibility, Kristine was put on intravenous feeding for most of the first week, slowly working her way back up to solid food. After ten days, she was released from the hospital.

Kristine Kelaghan

Hitting the twenty-eight-week mark was a huge relief — should her intestine have required surgery, survival rate for the baby is much higher after the lungs develop, says Degli-Esposti. The medications, however, seemed to be working well — and the baby showed healthy growth, even though Kristine had gained almost no weight, a symptom of her body’s impaired ability to absorb nutrients.

Babies born to mothers with Crohn’s tend to be small, but Kristine gave birth two weeks early to a healthy, eight-pound, fourteen-ounce daughter. “Everyone at Women & Infants deserves a lot of recognition,” Kristine says. “We love Dr. Degli-Esposti. She always goes the extra mile.”

While Kristine now realizes she showed symptoms of Crohn’s — pain, diarrhea, vomiting — before the pregnancy, she brushed them off. “This is particular to women,” says Degli-Esposti. “We’re so familiar with menstrual cramps, we ignore abdominal pain.” She encourages women to take their symptoms seriously. “There is the worry of being a complainer, but we should feel free to talk to our doctors,” she says. “Pain is never normal.”

 


 

James Klinger, M.D.

The Mother of All Fights
Wendy Foley is gracious, upbeat and laughs easily. In a battle for her life, this young mom doesn’t take any day for granted.

Thirty-six-year-old Wendy Foley was twenty weeks pregnant when she began having trouble climbing stairs. The young, healthy mother chalked up her fatigue and shortness of breath to being pregnant while taking care of a nine-month-old daughter. (“She was six months when I found out I was pregnant with my second,” Wendy says. “Surprise!”) When she went for a routine check-up, however, 
her obstetrician didn’t like how Wendy looked. She sent her for an echocardiogram at Rhode Island Hospital, where Dr. James Klinger, director of the Pulmonary Hypertension Center, confirmed she was suffering from pulmonary hypertension, an autoimmune disease that causes the arteries to the lungs to become hard and narrowed, overtaxing the heart as it struggles to pump blood.

“Everything steamrolled,” says Wendy, who spent twelve days in the hospital and lost the pregnancy. “I went in for an appointment and never came home that day — suddenly, it was no more children and a life-threatening illness.” It isn’t known exactly what causes pulmonary hypertension, which affects women about twice as often as men. “The life expectancy used to be three or four years, but with modern therapies people have lived much longer,” says Klinger.

The treatments require twenty-four-hour vigilance. Each month, Wendy re-ceives a shipment of epoprostenol, a powder she must mix with diluent daily and store in the refrigerator. Once liquid, the medicine’s forty-eight-hour shelf-life requires that it be kept cold and continuously administered by a catheter into her chest. “I have to bring back-up medication and an extra pump on ice with me wherever I go,” says Wendy, who explains that any interruption in the medication could be fatal within minutes. In addition to wearing the catheter and pump, she takes oral medications and wears an oxygen mask at night. “It’s all kind of inconvenient,” she says with a laugh. “I can never just pick up and go.”

Eventually, Wendy will need a double lung transplant; she is on waiting lists at Brigham & Women’s in Boston and the Cleveland Clinic, where wait-times for lungs can vary from months to longer than a year. “I go for evaluations in Massachusetts and Ohio every three or six months,” Wendy says. “If they notice any change, they will advance me on the list. The idea is to keep you in your lungs as long as you can safely stay in them.” In addition to not knowing when she will need the transplant or how long she will wait for her lungs once she does, the prognosis after surgery is uncertain. “Some people have lived ten years or longer,” says Klinger.

It is still a shock how quickly it happened. In 2002, Wendy was an athlete and a nurse starting a family. (“My nursing background means I know more than I want to know about some of the medical stuff, like surgery,” she jokes.) Almost overnight, she became a mother wondering how much time she will have with her now six-year-old daughter. “My daughter knows my lungs don’t work the way they’re supposed to,” says Wendy. “My husband and I have told her I may have surgery to get a new set of lungs, but we haven’t told her much more than that.” She laughs when she adds, “We try to be as honest as we can with a six-year-old.”

Klinger gives his patient enormous credit for her success thus far. “Wendy is an absolute trouper,” he says. “It’s a long road and a lot of people get discouraged. I know the stress on her, but she understands and accepts what she has, and she does everything she needs to do.”

Wendy Foley

 “Some days are better than others, but I try to have a sense of humor about it,” says Wendy. “It does get tough, but it’s your life you’re fighting for. Dr. Klinger has been great and very supportive. When he first told me my diagnosis, he said, ‘Wendy, I just want you to go home and live your life.’ I’ve had that echoing in my mind for five years. And I’m lucky to have good family and friends who help me out.”

She sees one bright side to her illness. “It certainly gives you a zest for life,” she says, laughing again. “I really want to live! I want to see my daughter grow up and go to college and get married. Every morning when I wake up, I’m just grateful to be here for one more day with my family.”

 

 

Baby Steps
You may think you want to be a child again, until you have to relearn to walk, talk and eat. After a mysterious disease forced her to do exactly that, Fanny Kwolek is happy to feel like herself.

Fanny Kwolek is instantly charming, the kind of lively Italian grandmother who tells stories with her hands and won’t let you out of her kitchen without taking some food with you. It’s hard to imagine that a year ago she struggled to walk, talk or eat.
Her illness started as a mystery. Just weeks after she had a dental plate in her mouth replaced, Fanny had trouble swallowing. Her daughter-in-law, Kathy, brought her back to the dentist to have the plate resized, but her symptoms only grew more severe. She choked and gagged on her food. She slurred her words. “It was scary,” Fanny says. Repeated trips to the dentist produced no answers, nor did a visit with an ear, nose and throat specialist. Soon, Fanny was having trouble holding her head up. She 
hunched over when she walked and had difficulty keeping her balance.

Elaine Jones

“It was frightening for all of us,” says Kathy, whose family lives next door and watched Fanny deteriorate almost overnight, shedding thirty pounds from her 
already petite frame. Her doctor soon recognized that the dental plate was a red herring and sent her to Dr. Elaine Jones, 
a neurologist at Roger Williams Medical Center. Jones immediately noticed the way Fanny’s speech and posture worsened the longer she talked and walked, and diagnosed her with myasthenia gravis, a disease that causes the muscles to become easily depleted. “It’s a problem with the communication between the nerve and muscle,” explains Jones. “It’s fairly rare, and tricky to pick up, but that fatiguing aspect kind of clues you in.”

The cause of this neuromuscular disease isn’t well understood — a tumor in the thymus gland can sometimes be the culprit, but Jones isn’t sure what triggered Fanny’s condition. “Myasthenia is in the same category as lupus and MS,” says Jones. “We don’t understand why they happen — it’s possible that a virus causes the immune system to rev up and make cells that break down your own tissue.”

Like the diagnosis, treating the disease also proved to be a matter of trial and error. Fanny’s symptoms didn’t respond to the medications typically prescribed for the disease, and her stooped walk was uncommon. “Myasthenia usually affects the face and throat,” Jones says. While she worked to find relief for Fanny, the eighty-two-year-old began the exhausting pro-cess of relearning how to chew, swallow, talk and walk. Her days and months became a revolving door of speech, physical and occupational therapists. “The first couple of weeks, I was going crazy,” Fanny recalls. “Mashing food, learning to drink, learning ‘do re mi fa so’….” She laughs and shrugs. “What are you going to do?”

It was about six months before a medication finally worked to restore Fanny’s functionality — almost immediately, she felt like her old self again. Still, she resists the urge to ignore doctor’s orders now that she is feeling good, keeping up with the twice-daily exercises her physical therapists prescribed to keep her muscles active. “Sometimes I don’t feel like doing them, but I don’t want to go through that again!” Fanny says.

Her ordeal was made easier by a wonderful team of nurses, therapists and doctors, says Kathy. Both women rave about Jones. “She’s just special. She listens,” Kathy says as Fanny nods her approval. “It was a real partnership between us. You can tell she cares.”

Kathy and Fanny Kwolek

The feeling is mutual. “One of the things that struck me about Fanny and her family was their persistence in continuing to ask questions until we got answers,” says Jones. “They were very good at commu   nicating — never complaining, but telling me the specifics of what she was dealing with and any new issues that came up.”

Fanny laughs when asked how she kept her good attitude, but her daughter-in-law doesn’t let her get away without some praise. “It comes naturally to her,” Kathy says. “She has a strong spiritual background and she just never gives up. With everything she had to go through, she never complained.”

Fanny, of course, waves off the compliment. “My father used to tell me the more you complain, the more people will push you down,” she says. “He always told me to try to be different. Try to be a fighter.”

 

For the list of this year's Top Docs for Women, click here.