Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF Nov. 7, 2014 | Archived Issues

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CME Newsletter - November 2014 (PDF)


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Multidisciplinary Clinics Give IBD Patients Hope

Nada Zahr-Gallagher, with daughter Lillie, was "a perfect candidate" to join a new Cedars-Sinai program for pregnant women with inflammatory bowel disease, said Gil Melmed, MD, MS.

Nada Zahr-Gallagher had been battling digestive illness since she was a teenager, but when she was 29, caring for a husband recovering from illness and with two young children, she became very ill. Doctors discovered a blockage in her intestines, and she was diagnosed with Crohn's disease, a form of inflammatory bowel disease (IBD).

"For six months I could barely walk. I felt really helpless," Zahr-Gallagher said. "I tried nearly every medication prescribed for the disease at that time, but nothing helped. I was at my worst when I finally came to Cedars-Sinai."

Zahr-Gallager was referred to Gil Melmed, MD, MS, director of clinical trials for the Inflammatory Bowel Disease Center.

Melmed (right) "was like a compassionate detective who was really on my side," Zahr-Gallager said.

"The first time I met with Dr. Melmed, he handed me a box of tissues and I cried for two hours," Zahr-Gallager said. "He asked me a lot of questions, not just about my health, but about my life. He was like a compassionate detective who was really on my side."

"IBD is a chronic illness, not a terminal illness, and it impacts a patient's quality of life for a long time. The treatment decisions we make have to look at the whole person and how they live," Melmed said.

Within weeks of seeing Melmed, as she was about to begin a clinical trial, Zahr-Gallagher discovered she was pregnant. She had to postpone plans to be part of the drug study, but pregnancy put her in the position to be one of the first participants in a new multidisciplinary approach to treating IBD.

"She was a perfect candidate for our new program called Pregnancy and Fertility in IBD," Melmed said. "She had complex IBD, had been on complex therapies over the course of her disease and she had a whole pregnancy ahead of her. We wanted to be proactive about managing her care."

Zahr-Gallagher had "tag-team" care during her pregnancy. To treat and support her, Melmed joined with maternal-fetal health expert Sarah Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology at Cedar-Sinai.

"I was getting expert care for my Crohn's disease and my high-risk pregnancy at the same time," the 36-year-old mother of three said. "I wanted a healthy baby, and I was so reassured by both Dr. Melmed and Dr. Kilpatrick."

"For the very first time in a long time, I feel that I am in a good place, the right place," Zahr-Gallagher said.

The goal of the IBD multidisciplinary clinics is to provide highly coordinated care for patients with chronic illness who often are on immunosuppressive treatments.

"Patients with additional medical issues sometimes receive conflicting messages from doctors in other specialties. We wanted to address that problem," Melmed said. "The level of coordination and expertise offered by a synchronized, multidisciplinary, 'one-stop shopping' approach leads to very high patient satisfaction."

Cedars-Sinai offers four multidisciplinary IBD programs, providing treatment options for IBD care that are unique in the U.S., according to Melmed. In addition to the pregnancy/fertility program, there are coordinated care programs in nutrition, mental health and ileoanal anastomosis, or J-pouch, surgery, which is a treatment option for some patients with ulcerative colitis.

One year ago, Zahr-Gallager delivered a healthy baby girl, Lillie. She also has started a recently approved treatment for IBD at Cedars-Sinai.

"For the very first time in a long time, I feel that I am in a good place, the right place," Zahr-Gallagher said. "From the paperwork to the people who greet you to the people who treat you, I feel well cared for."