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Top Doctors for Women

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Dr. Barbara McGuirk

Reproductive Endocrinology

Dr. Barbara McGuirk is saddened to see women waste most of their reproductive years on antiquated treatments because, when it comes to fertility challenges, time is of the essence.

McGuirk serves many women over 40, many who have had successful careers and wish to start a family later in life. “But the problem with women is that our ovaries only want the pregnancy event for a certain number of years,” says McGuirk. “And at the age of 40, there are ovary-aging issues that you can’t stop.”

There are other issues, as well. As one of the nation’s premier reproductive surgical specialists, McGuirk treats diseased Fallopian tubes, pelvic scarring from prior infection or surgery, and polyps and other abnormalities of the uterus. She also manages problems related to infertility, recurrent pregnancy loss, amenorrhea (absence of menstruation), abnormal uterine bleeding and endometriosis (the presence of endometrial tissue, which normally lines the uterus).

One in seven couples, she says, is infertile.

“Typically, someone would say of those couples that a third is a female issue, a third is a male issue, and a third is both,” McGuirk says. “The infertility world would say 33 percent are unexplained. We don’t call it unexplained. We call it unexplored. There is an explanation. You have to be willing to look for it.”

At Reproductive Associates of Delaware in Newark, a center she founded in 1996, only 3 percent of cases are unexplained.

After completing her fellowship in reproductive endocrinology at the University of Pennsylvania Medical Center in 1994, McGuirk created Reproductive Associates to address each patient’s specific needs, which is what sets her apart from other reproductive specialists.

“There was a certain type of fertility care that I wanted,” she says. “Our job is to give patients a diagnosis, to be compassionate, skillful and to evaluate. Once you have the diagnosis, you are able to move forward with treatments.”

About 80 percent of McGuirk’s patients undergo fertility treatment. Others suffer from severe pelvic pain or uterine fibroids (benign tumors made up of fibrous and muscular tissue in the uterine wall), which can cause infertility.

To remove fibroids, she inserts a laparoscope through a small incision in the abdomen, then, guided by a fiber-optic camera, removes the growths. “What I’m able to do is laparoscopically suture the fibroids,” says McGuirk. Small incisions mean a quicker, easier recovery period and less postoperative pain than traditional open surgery.

McGuirk and her partners have performed more than 2,500 reproductive laparoscopy procedures. Few doctors are willing to do the surgery, mainly because of the difficulty, but also because inadequate suturing has led to reports of uterine rupture during pregnancy and labor.

McGuirk has also developed a unique skill in laparoscopic repair and reattachment (anastomosis) of tied Fallopian tubes. In other words, she can reverse tubal ligations for women who’ve had second thoughts about having children.

Patients often approach McGuirk after being told they need in vitro fertilization. “But after we’ve actually surgically corrected them, there’s a large group of patients who don’t need IVF,” she says. “They spontaneously conceive or go through lesser means [to ensure] pregnancy, which could be with low doses of clomid (a drug that stimulates ovulation) with possible insemination.”

Board certified in reproductive endocrinology-infertility and obstetrics and gynecology, McGuirk regularly attends conferences of the American Fertility Society and the American Association of Gynecologic Laparoscopists.

“We are unique in the fertility realm in that we think out of the box all the time,” McGuirk says. After working up a comprehensive history on a patient, she says, “75 to 80 percent of the time, we know what’s wrong without ever touching her.”

Dr. James Manley

Maternal Fetal Medicine

Unlike many of his colleagues in maternal fetal medicine, Dr. James Manley is not keen on labeling every pregnant woman over 35 “high risk.”

“Doctors don’t focus on the positives enough,” Manley says. “Some make a big deal out of the fact that women are older or they stress the high-risk label when, really, the odds are in their favor that they’ll be fine. We like to be reassuring of that.”

Board certified in obstetrics and gynecology, Manley specializes in the diagnosis, treatment and care of expectant mothers and their unborn babies. A member of the Society of Maternal and Fetal Medicine, he completed his fellowship in maternal fetal medicine at the Pennsylvania Hospital in Philadelphia, then practiced in Christiana Hospital’s maternal fetal medicine division for 15 years.

Earlier this year Manley created the Delaware Center for Maternal Medicine. In its first three months, he treated 1,000 women.

“What that says to me is that how you treat the patients makes the difference,” says Elizabeth Williams, who manages Manley’s practice. The center averages 60 new referrals a week.

“I wanted to make all of our patients’ lives and their referring doctors’ lives easier by having access to us,” says Manley. “Waiting five weeks for an ultrasound (often the case at large institutions) was bad for the referring doctor. For the patient it was forever. And you shouldn’t have to write off a whole day to have an ultrasound.”

About 5 percent of Manley’s patients confront fetal abnormalities that involve neural tube defects such as spina bifida, one of the most common neural tube birth defects in Delaware. (The neural tube is the embryonic structure that develops into the brain and spinal cord.) Other defects can include achondroplasia (a form of dwarfism), cystic fibrosis (a disorder of lungs and other organs) and chromosomal abnormalities.

Manley consults regularly with couples who have had an affected baby or a family history of neural tube defects to discuss possible risks to future children. Down syndrome is the most common chromosomal abnormality. Other abnormalities are less or more severe. Some are fatal before birth. All are emotionally draining for expectant women. A sensitive bedside manner may not be a medical requirement, but it is one of Manley’s strong suits.

Fewer women in Delaware are experiencing multiple births, largely because reproductive endocrinologists are promoting single pregnancies as opposed to the riskier multiple births they favored in the recent past. Manley is concerned with Delaware’s growing obesity problem and has seen a marked increased in gestational diabetes (which can result when a woman is obese, diabetic or has high blood pressure). Obesity can lead to other serious complications for pregnant women.

Manley bases his practice on evidence-based medicine, which uses randomized controlled trials to render individual solutions for individual patients. Manley points to a national trial, conducted from 1998 to 2002 by the National Institute of Child Health and Human Development, which showed that progesterone treatment, started between the 16th and 20th week of pregnancy and continued through the 36th week, may help to reduce premature births among women who have a history of preterm labor and premature delivery. That’s critically important information to Manley. The premature birth rate has increased from 9 percent in 1986 to 12 percent today nationwide. Delaware mirrors those stats.

The Delaware Center for Maternal Fetal Medicine offers services such as maternal and fetal medical care, monitoring, ultrasound examinations, genetic counseling and testing (amniocentesis, first-trimester screening), diabetes education, state-of-the-art diagnostics and fetal well-being tests.

As a mother’s due date approaches, Manley remains in close contact with her and the obstetrician who will deliver the baby. He also consults with neonatologists who will oversee the infant’s care after birth.

“If there is a problem,” Manley says, “we will tailor a plan specific to the patient.”

Dr. Clara Higgins

General Surgery

Thyroid and bowel operations, colonoscopies and endoscopies are becoming more prevalent among women, yet Clara Higgins will perform more breast cancer surgeries than any other procedure.

Delaware is in bad shape where breast cancer is concerned, in terms of cancer per capita in the country,” she says. “When I was in training 10 years ago, we would quote about one out of 10 women who would have a problem with breast cancer. Now we’re quoting about one out of seven.”

Higgins completed her medical training and residency at the Philadelphia College of Osteopathic Medicine, then served at Philadelphia’s Graduate Health System/Parkview Hospital before joining Beebe Medical Center in Lewes in 2002, where she is now associate director of trauma.

At Beebe’s Tunnel Cancer Center, she regularly joins pathologists, radiologists, surgeons, oncologists and radiation therapists to discuss individual cases and determine the best treatments.

“You are able to coordinate the latest and most appropriate care,” says Higgins. “Patients are very happy when I tell them, ‘You’re going to be discussed at this particular conference.’”

Higgins specializes in sentinel node biopsies for breast cancer patients. “Instead of removing all of the lymph nodes, like we used to do, we now use a nuclear medicine called Technetium-99 and blue dye, and we’re able to identify a particular lymph node—the one that would first be involved with cancer if cancer was trying to spread,” says Higgins. She then removes that node.

Technetium-99 contains less radiation than a standard X-ray, CT scan or bone scan, and is considered relatively safe. The dye helps visually track the location of the sentinel node during surgery. Higgins uses a hand-held counter to detect the radioactive tracer to locate the node.

If the cancer has spread, the patient would continue to a standard axillary node dissection, which is the removal of the underarm lymph nodes. The axillary requires a larger incision and a longer recovery period.

“I always say that breast protection is three-fold: monthly self-breast exam, yearly exam by a healthcare professional and a yearly mammogram after the age of 40,” says Higgins. “If you do those three things, you might not prevent breast cancer, but you’d detect it early,” when the potential for successful treatment is greatest.

Lung, breast and colorectal cancers (in that order) are the biggest medical challenges facing women. In the case of lung cancer, however, most people do not undergo surgery because treatment involves radiation and chemotherapy, Higgins says. Still, lung cancer will be detected in 81,770 American women by the end of this year, and 72,131 women will die from it.

Higgins also sees a growing number of gallbladder cases in Delaware women. “Being female gives you more of a predisposition for the disease,” Higgins says.

Gallbladder disease is four times more common in women than in men. Women of childbearing age and those who struggle with obesity are most vulnerable, though the condition can strike anyone. Higgins’ youngest gallbladder patient was 12. Her oldest was 93.

Higgins also specializes in treating thyroid disorders, such as hypothyroidism, which results when the gland fails to produce adequate hormones. Overactive thyroid condition, called hyperthyroidism, means the thyroid produces more hormones than necessary. The thyroid regulates growth and metabolism, which affects heartbeat, cholesterol level, body weight, energy level, muscle strength, skin condition, vision, menstrual regularity and mental state. So thyroid problems have great impact on quality of life. Warning signs of a disorder include the appearance of nodules in the neck, increased fatigue and excessive sweating.

“Most of the time, you do surgery to make sure that patients don’t have thyroid cancer. If they do, it’s treatable,” Higgins says. Surgery usually fixes the problem, but some patients require treatment with radioactive iodine, which burns away remaining cancerous tissue.

Of greater concern to Higgins, however, is colon (or colorectal) cancer, which is reaching epidemic proportions among women. According to the American Cancer Society, 57,460 women will be diagnosed with colon cancer this year. Of those, 27,300 will die.

Colon cancer can be detected early via a colonoscopy. In colorectal cancer’s early stages, changes in the colon’s lining or rectum occur and polyps may appear. Removing them may prevent cancer from developing. “That’s why we’re pushing for people to get those colonoscopies,” Higgins says. “They can save lives.” The process involves passing a colonoscope (a long tube with a lens and light at the end) through the rectum and colon. Sedated patients often sleep through the procedure.

Higgins deals with emotionally charged issues every day. Her main job, she says, is to provide alternatives.

“When I was in medical school, one of my professors shared with me that you have to honest with the patient, whether it’s positive or negative news,” she says. “I always say that God is in charge. I’m the helper.”

Dr. Mark Borowsky

Gynecologic Oncology

Gynecologic oncology is the care of women with malignancies of the gynecologic organs, which can include uterine and ovarian cancers as well as cancer of the Fallopian tubes, vagina and vulva.

The field evolves constantly, which is why Dr. Mark Borowsky, director of gynecologic oncology at Christiana Hospital’s Helen F. Graham Cancer Center, participates in a national research cooperative called the Gynecologic Oncology Group. At Christiana, which is affiliated with the National Cancer Institute, Borowsky leads a team that offers surgery, chemotherapy and radiation.

Borowsky began his medical training at the University of Pennsylvania and completed his residency at North Shore University Hospital of New York University. After four years at Bayhealth Medical Center in Dover while in the U.S. Air Force, Borowsky completed a fellowship at the State University of New York. A member of the Society of Gynecologic Oncologists, he is board certified in both general gynecology and obstetrics and gynecologic oncology.

When Borowsky joined Christiana last year, the Graham Center treated an average of 95 patients a month. Today it treats at least 250.

“We see the full spectrum of gynecologic cancers, and just as in nationally, the majority of those patients have uterine cancer,” Borowsky says. “The next most common is ovarian cancer. We have our share of patients with cervical cancers as well, but the particular issues relevant to which patients develop those diseases have to do with the areas we draw from.”

Those areas include the inner city of Wilmington and rural areas—areas that produce what Borowsky calls an overrepresentation of cervical cancer among women who do not get regular screenings or Pap testing. (The Pap test, or Pap smear, checks for changes in the cells of the cervix.)

Borowsky says excessive weight has become a major issue in incidences of cancer.

“With respect to gynecologic oncology, we’re seeing more patients with endometrial cancer (cancer of the uterus), which, among other factors, is caused by obesity,” he says. “This is one of the cancers that’s increasing in Delaware and in the nation.”

Though endometrial cancer once occurred mainly in postmenopausal women, Borowsky is treating women in their 20s and 30s. “That has implications with respect to fertility that we didn’t used to have,” he says.

Among Delaware women, ovarian cancer, the deadliest of all gynecological malignancies, is usually detected at advanced stages. Because ovarian cancer is hard to detect, about 75 percent of its victims don’t see an oncologist until the disease has progressed to Stage III or IV. There are few symptoms (abdominal pain, change of appetite), and patients often ignore them.

“And not just that,” Borowsky says. “Often times when [women] do present to the physician, they are reassured that it’s likely to be a gastrointestinal ailment that’ll pass, or they’re reassured that a change in appetite is due to some other factor.”

For instance, unexplained weight loss or abdominal bloating might be warning signs. Borowsky urges women who face such issues to consult their gynecologists. During pelvic exams, doctors can feel the size of the ovaries. “You don’t expect to feel a large mass on a biannual examination, but if you feel a tennis ball or a grapefruit, that’s picking up a mass that might be malignant, but still might be early-stage disease,” he says.

Yearly gynecological exams are a must, yet many women stop visiting their gynecologists after menopause. Younger women are putting off their gynecological visits for two- to three-year stretches.

Borowsky believes new studies offer hope for cancer patients. A trial completed by the Gynecologic Oncology Group in January compared the use of intravenous chemotherapy to treat ovarian cancer to the use of chemotherapy delivered both intravenously and directly into the abdominal cavity (called intraperitoneal therapy). Intraperitoneal therapy showed a substantial survival advantage. “So we now give intraperitoneal chemotherapy to all our eligible ovarian cancer patients as a result of that trial,” Borowsky says. He is also involved in a Gynecologic Oncology Group test of Avastin on ovarian cancer. The drug has produced excellent results in people with advanced colon cancer.

Though he knows the road to a cure is a long one, he will continue to participate in similar national clinical trials while serving Delaware’s growing number of cancer patients. Says Borowsky, “The trials lead the way toward the treatments of tomorrow.”

Dr. Michael Zaragoza

Urology

Women talk about sex and hot flashes without hesitation. Rarely do they openly discuss urinary incontinence. Perhaps that would change if they knew that urinary incontinence affects 33 million American women every year.

“When you talk about incontinence, it doesn’t always come up on the radar screen because it isn’t a life-threatening condition,” says urologist Michael Zaragoza, medical director of the Continence Center at Bayhealth Medical Center in Dover. “But it has a huge quality-of-life impact. The things that are affected when somebody can’t control their bladder are so substantial that it affects every aspect of their life.”

The problem is that many women have been taught that incontinence is a normal part of aging. It isn’t.

“It’s way down on the list, and a lot of doctors won’t even bring it up unless the patients do,” says Zaragoza. “So you have to have some kind of impetus on both sides to increase the awareness. Once the problem is realized and people understand there is a logical way to deal with and treat it, more people will get that problem under control.”

Zaragoza, who completed his surgery residency at Eastern Virginia Graduate School of Medicine and finished his urology residency at University of Michigan in 1993, is a diplomat for the American Board of Surgery. He is also an associate editor of the Delaware Medical Journal and a consultant for the Journal of Urology who has published widely.

Actively involved in extensive clinical research, Zaragoza says that, though urinary incontinence could always be treated, there are now more options available for sufferers.

In order to treat the condition properly, patients should understand that incontinence is broken down into two broad categories: stress (the loss of urine as a result of physical activity like lifting—even coughing—due to weakened pelvic muscles) and urge, which is caused by inappropriate bladder contractions. Medical professionals often describe urge incontinence as “unstable,” “spastic” or, more commonly, “overactive.” It is often attributed to stroke, spinal cord injuries or diabetes, among other conditions. And some patients suffer both stress and urge—or “mixed”—incontinence.

Zaragoza’s treatment for stress incontinence is aimed at restoring support underneath the weakened bladder. The most effective means is surgery, which raises the bladder to its normal position. For lower degrees of incontinence, he prescribes less-invasive means like Kegel exercises (which retrain the sphincter and muscles of the pelvic floor) or physical therapy.

Zaragoza’s clinic also offers biofeedback therapy: inserting electrodes into the vagina to stimulate nearby muscles, thus stabilizing overactive contraction of the urethral muscles. The treatment reduces both stress and urge incontinence.

Zaragoza is a member of the Society for Urodynamics and Female Urology, an international nonprofit that aims to improve the art and science of urology through applied clinical research. (Urodynamics is the study of the transport, storage and expulsion

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