By Dr. Leila Haghighat, Vitals contributor
Christmas Day back home in Michigan started just the way Lucy Hanna had imagined—a lively gathering of family and friends, all excited about her pregnancy. Then came a sharp cramp in her abdomen.
She hurried upstairs to use the bathroom and, looking into the toilet bowl, saw mucus and blood. Lucy immediately recognized the symptoms. After nearly a decade in remission, her ulcerative colitis, a form of inflammatory bowel disease, or IBD, was flaring again.
Her thoughts went instantly to her baby.
Once she gathered herself, Lucy reached out to her gastroenterologist with the Palo Alto Foundation Medical Group (PAFMG), Dr. Ryan McConnell. From California, Dr. McConnell, Associate Medical Director of Inflammatory Bowel Disease at Palo Alto Medical Foundation, quickly arranged steroid treatment to control her worsening symptoms, including urgent bowel movements occurring up to ten times a day. Earlier in her pregnancy, Lucy could run. Now, she rarely left the house, afraid she might not make it to a bathroom in time.
“I was so good until I wasn’t—and that’s kind of the nature of this chronic disease,” Lucy said. “You feel well for so long, and then suddenly it becomes very debilitating.”
Dr. McConnell increased the frequency of the medication that had been controlling her disease for years. Eventually, at 38 weeks, Lucy delivered a healthy baby boy.
For patients like Lucy, navigating IBD is rarely straightforward—especially during major life transitions such as pregnancy. It’s why comprehensive, specialized care can make such a profound difference.
Understanding IBD
IBD is a chronic condition that causes inflammation in the gastrointestinal tract. The two main forms are Crohn’s disease and ulcerative colitis. Symptoms can vary widely but often include diarrhea, abdominal pain, fatigue, joint pain, and skin rashes.
“Bathroom-related symptoms are social taboos, so many patients suffer in silence,” Dr. McConnell said.
Beyond the physical symptoms, IBD can significantly affect quality of life, making travel, work, exercise, pregnancy, and even daily routines difficult during active disease.
Patients with IBD also face an increased risk of colon cancer, often requiring earlier and more frequent colonoscopies.
Expanding Options for Patients with IBD
As treatments for IBD have rapidly evolved, patients increasingly benefit from specialized care teams familiar with advanced therapies and long-term disease management.
While milder IBD can be managed with oral medications, more advanced cases require newer therapies known as biologics or small molecules. These are highly specialized medications targeting the immune system that are frequently given as infusions or injections and need close monitoring.
In Palo Alto, the IBD program includes staff dedicated exclusively to the care of patients with IBD. This includes a nurse practitioner and a patient coordinator dedicated to facilitating insurance approval of costly medications. The program also implements intestinal ultrasound, an emerging bedside technology that complements traditional diagnostic testing and allows physicians to assess inflammation during a clinic visit in real time.
More Challenges Ahead
A week after giving birth, Lucy’s symptoms worsened again. She began needing the bathroom more and more frequently, and when fevers developed, she was hospitalized.
The separation from her newborn son was devastating.
Dr. McConnell guided her through another therapy transition, starting intravenous treatment that stabilized her symptoms enough for her to return home. But soon afterward, Lucy developed severe joint pain—so intense that she struggled even to hold her baby.
After extensive conversations about risks, benefits, and future family planning, Dr. McConnell recommended switching to a newer medication, upadacitinib. The decision was not easy. Because of the medication’s safety profile, Lucy could no longer continue breastfeeding.
But within weeks, her symptoms almost entirely resolved.
“I couldn’t have asked for better care,” Lucy said. “Even when I was hesitant about starting a new medication because of the side effects, Dr. McConnell reassured me and answered all my questions about what the future could look like, including if I wanted another pregnancy.”
Looking Forward
Dr. McConnell hopes to continue expanding the program through clinical trials, bringing therapies traditionally available only at major academic centers into a community-based setting.
Two clinical trials are currently enrolling in Palo Alto, including one studying whether spinal nerve stimulation may help reduce IBD symptoms.
“It’s exciting to offer clinical trials in a community practice,” Dr. McConnell said. “For some patients, it’s an opportunity to access promising therapies earlier. For others who may have exhausted standard treatments, it can provide hope when options are limited.”
The program also participates in nationwide quality improvement initiatives through the Crohn’s & Colitis Foundation IBD Qorus network. Recent projects have focused on improving anemia and reducing avoidable emergency room visits and hospitalizations among patients with IBD. For its high level of engagement in the network, the team received a Gold Status recognition.
As the IBD program continues to grow, patients like Lucy are seeing possibilities that did not exist even a decade ago. Today, she is home with her healthy baby boy, grateful that what began as a gut-wrenching setback ultimately became a story of resilience through the support of specialized medical care.
