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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.

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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.

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.

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.”

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.”

 “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.”