Allegheny Health Network

Brianna DiSilvio, MD
Credit: Allegheny Health Network

Interstitial lung disease (ILD) is a diagnosis that challenges even the most seasoned healthcare professionals. With more than 200 lung disorders that fall under the ILD classification, they all involve inflammation, fibrosis, and relentless respiratory compromise.

Its stealthy progression and numerous manifestations require specialists to effectively manage the disease. The AHN Autoimmune Interstitial Lung Disease (AI-ILD) clinic breaks down barriers to care for patients with a multidisciplinary one-stop approach. It unites rheumatology and pulmonology to provide patients with tailored care quickly and efficiently.

“Collaborative care for ILD patients is hard to provide when this complex disease is being managed by two separate providers who may not be on the same page,” said Briana DiSilvio, MD, Pulmonary and Critical Care specialist. “Pulmonology and Rheumatology visits may be scheduled months apart for patients, resulting in communication challenges and interruption in treatment decisions.”

Dr. DiSilvio works side-by-side at the clinic with Joanna Marco, MD, AHN rheumatologist. Combined visits allow the team to get patients on the right track for therapy more quickly. In the traditional model of siloed subspecialty care, patients may spend six months to a year playing catch up with their providers, waiting for a cohesive management plan to be decided upon. That delay is effectively eliminated at the AI-ILD clinic, where treatment success along with shortcomings in therapy regimens are recognized earlier, and opportunities for medication alteration can happen sooner.

“If a patient says they’re having trouble walking up the stairs, Dr. DiSilvio and I are together figuring out if it’s because their lungs are acting up, or their arthritis, or their muscle disease is bad,” Dr. Marco explained. “Together in real time, we’re discussing workup and treatment options, and this is a huge benefit to our patients.”

The common link between the many forms of ILD is inflammation in the interstitium – the scaffolding that supports the lungs’ structure. These diseases inflame or scar the lungs, causing pulmonary fibrosis and destroying the air sacs.

Symptoms are different for each patient and may look like other lung conditions or health problems. But the most common red flags that warrant a specialist visit include persistent and progressive dyspnea, particularly in the absence of an obvious etiology; unexplained cough; bibasilar crackles on auscultation, or radiographic abnormalities on chest imaging.

As gatekeepers of patient care, primary care physicians play a pivotal role recognizing the telltale signs of ILD and facilitating timely referral to specialized care, Dr. DiSilvio said.

“Our referring colleagues are our partners in helping patients grappling with this challenging condition, Dr. DiSilvio said. “We’re grateful we can work together to alleviate the burden of the disease and empower our patients to start on a path of healing.”

While a cure for ILD remains elusive, treatment goals focus on mitigating symptoms, halting disease progression, and improving quality of life.

Pharmacological interventions, including corticosteroids, immunosuppressants, and antifibrotic agents, are the main options for medical management. Supplemental oxygen therapy plays a pivotal role in alleviating hypoxemia and enhancing patient comfort.

Also, pulmonary rehabilitation offers a holistic approach to symptom management through exercise training, education, and psychosocial support.

As part of the AHN Autoimmunity Institute, the Autoimmune ILD clinic works closely with the nurses, mental health staff, and pharmacists at the institute. Dr. Marco said blending rheumatology and pulmonary to care for these patients has led to improved communication and shared decision making.

“Dr. DiSilvio and I each have to show humility and listen to one another’s opinions,” Dr. Marco said. A patient’s joint disease may be well-controlled, but their lung disease is not. Or maybe they’re doing well from a respiratory standpoint, but they have muscle pain and skin rashes. It’s a give and take. We come together, each with our own expertise, but we know when to defer to the other to take the lead on a patient’s care, and vice versa.”

The Autoimmune ILD clinic has had extremely positive patient satisfaction results. Patients say visiting their doctors at one location, at one time, has reduced the stress and physical impact they previously felt with multiple office visits.

“Going back and forth between providers and waiting for treatment decisions to be made – all of that is an emotional burden on patients,” Dr. DiSilvio said. “We really work to eliminate that and to let patients know we’re on the same team.

To get more information or to refer a patient, call 412-578-3511.

Articles

AHN's AI-ILD clinic provides collaborative care, uniting pulmonology and rheumatology specialists for efficient treatment of ILD.

AHN Multidisciplinary Team Successfully Transforming Interstitial Lung Disease

Marcia Klein-Patel, MD, PhD
Credit: Allegheny Health Network

One in three women will experience a pelvic floor disorder during her lifetime, due to weakened pelvic muscles or tears in the connective tissue. The most significant barriers to treatment are embarrassment and lack of awareness about therapeutic options.

Allegheny Health Network (AHN) has a program dedicated to treating women throughout all stages and ages of life — from pregnancy and post-pregnancy to menopause and post-menopause. The highly specialized AHN team collaborates closely with patients to fully understand their challenges and design a comprehensive treatment approach that meets their long-term health goals and improves their quality of life.

“Pelvic floor complications are, in fact, the most common health issues experienced by women after pregnancy and continue throughout their lives,” said Lindsay Turner, MD, urogynecologist at AHN West Penn Hospital. “However, these complications are often left untreated due to persistent stigmas or the general assumption that it’s simply something women have to live with — and it’s important we communicate that’s just not the case.”

AHN’s multidisciplinary team includes urogynecologists, gastroenterologists, and colorectal surgeons that work together to design comprehensive care plans to alleviate discomfort, improve quality of life, and meet patients’ desired health goals. Pelvic health physical therapists also work with patients via telemedicine or in-person appointments.

Diagnosing a pelvic floor disorder can be challenging, particularly because of similar symptoms across pathologies, said Marcia Klein-Patel, MD, PhD, chair of the AHN Women’s Institute. She explained how referrals from colleagues to AHN’s urogynecology program have significantly improved many women’s lives because of the specialized and tailored care.

“By pushing these conditions into the mainstream, reducing associated stigma, and increasing access to tailored care, we can give women a renewed sense of confidence,” Dr. Klein-Patel said.

Among the most common symptoms experienced by women with pelvic floor issues are chronic pelvic pain, urinary frequency or urgency, urinary leakage, painful sex, vaginal or rectal prolapse, bowel leakage, and constipation.

AHN’s treatment options include pelvic floor physical therapy, medications, biofeedback, relaxation techniques, nerve stimulation, and minimally invasive pelvic reconstruction procedures that target specific areas of concern.

To refer a patient to the AHN Urogynecology Program, call 412-DOTORS or visit https://www.ahn.org/health-care-professionals.

AHN's urogynecology program offers comprehensive care for pelvic floor disorders, breaking barriers with tailored treatment plans for women's health.

Encouraging Women to Seek Help for Pelvic Floor Dysfunction

Dr. Ghosh received her medical degree from Northeast Ohio Medical University in Rootstown, OH. She completed a residency in internal medicine and pediatrics at Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, OH. She furthered her training with a three-year fellowship in pulmonary and critical care and a second, one-year fellowship in interventional pulmonary, both at the University of North Carolina, Chapel Hill.

Dr. Ghosh is a member of the American Association for Bronchology and Interventional Pulmonology, the American Thoracic Society, and the American College of Chest Physicians. She has authored numerous articles, presented multiple abstracts for research, and has lectured to students and medical audiences around the country.

AHN Physician Spotlight

Dr. Kislovskiy is an OB-GYN with special training in reproductive infectious disease. She provides comprehensive care for patients within AHN Women who live with HIV, peripartum challenges, and severe gynecologic infections. She also focuses her efforts on preventive health solutions and treatment for various sexually transmitted diseases.

Dr. Kislovskiy earned her medical degree from Michigan State University College of Human Medicine in East Lansing, Michigan. Her residency was completed at University of Pittsburgh Medical Center, Magee-Womens Hospital in Pittsburgh, Pennsylvania. She remained with this same hospital for completion of her fellowship in Reproductive Infectious Diseases and Immunology.

Dr. Kislovskiy holds certification with the American Board of Obstetrics and Gynecology, as well as the American Academy of HIV Medicine. Her academic contributions include serving as clinical instructor for the Department of Obstetrics, Gynecology, and Reproductive Sciences at Magee-Womens Hospital. Patients can make an appointment to see Dr. Kislovskiy at Allegheny Women’s Health in either Pittsburgh or McCandless.

https://findcare.ahn.org/Yasaswi-Kislovskiy

Dr. Homa specializes in reproductive endocrinology and infertility. She treats women with fertility problems, fibroids, hormone disorders, and disorders of sexual development. She also offers gynecological care to children and adolescents. She is experienced at minimally invasive surgery. Her clinical interests include fertility problems, fibroids, hormone disorders, sexual development, and pediatric and adolescent gynecology. She speaks English.

Thomas Krivak, MD is the director of the Ovarian Cancer Center of Excellence and co-chair of the Society of Gynecologic Oncology Research Institute. He specializes in treating ovarian, uterine and other gynecologic cancers and has particular expertise in minimally invasive surgical techniques, as well as non-invasive options.

Dr. Krivak received his medical degree at Ohio State University College of Medicine and performed his residency at David Grant Medical Center, Travis Air Force Base in California. He completed his fellowship at the Walter Reed Army Medical Center in Washington, DC and at the National Cancer Institute, Rockville, Maryland. Dr. Krivak is board-certified by the American Boards of Obstetrics and Gynecology and Gynecologic Oncology. He was named one of Pittsburgh Magazine's "Best Doctors" in 2019.

Dr. Turner earned her medical degree from the Loyola University in Maywood, Ill. She completed her obstetrics and gynecology residency at the Magee-Women’s Hospital of UPMC in Pittsburgh, Pa., where she was chief resident. She continued at Magee-Women’s Hospital to complete a fellowship in female pelvic medicine and reconstructive surgery. During her fellowship, she completed a master’s degree in clinical research.

She is a member of the American College of Obstetricians and Gynecologists and the American Urogynecologic Society. She is well-published in various medical journals, including the International Urogynecology Journal and the American Journal of Obstetrics and Gynecology.