We asked local physicians which medical specialists they would most often recommend to a loved one. Here are their choices, with health advice from seven of the very best in their fields. For the list of 163 Top Doctors and details of our methodology, scroll to the bottom.
 

Vanita D. Jain, MD

This modern life leads to all kinds of behaviors that have serious implications for human health.

Take pregnancy. There is an optimal age range for women to bear children, says obstetrician-gynecologist Vanita Jain: roughly 15 to 30 years old. “No one wants 15-year-olds to get pregnant,” before they’ve developed the experience, skills or financial means to become good parents, says Jain, which leaves a window of 20 to 30.

Until 30 years ago, plenty of women in their 20s put family first. Today, many women of the same age have other priorities, such as education and career. Overall, Americans start their families later in life, and that can mean greater risk of health and medical complications for mother and child.

Jain’s practice monitors, among others, women near or at the limit of their child-bearing years. Among them occur two chief health issues: chronic hypertension and gestational diabetes. They may complicate only 20 percent of pregnancies, but those complications are significant.

Chronic hypertension increases the risk of bearing a small baby, preeclampsia (reduction of the amniotic fluid that protects the fetus), pre-term birth and still birth. Gestational diabetes—the body’s inability to regulate blood sugar—increases the risk of heart and spine defects in the baby and can lead to high birth-weight babies, which could require delivery via a Caesarian section, leading to implications for future deliveries.

Jain’s practice intensively monitors fetal development through ultrasound surveillance of older mothers and at-risk mothers. Treatment of chronic hypertension and gestational diabetes can require medication, though treatment can sometimes be as simple as changing a diet. Jain stresses consulting your primary care physician before you get pregnant, then following up after delivery. Developing gestational hypertension and diabetes increases a mother’s risk of developing hypertension and Type II diabetes as soon as three years after giving birth.

Jain won’t preach about lifestyle choices from on high. She counts herself among the women who focused on career before family. She started at 34, delivering a pre-term boy who weighed 4 pounds, 2 ounces. “It has made me a better maternal-fetal doctor,” she says. “It’s hard to see your child in the [neonatal intensive care unit]. I tell my patients, ‘I’ve been there.’”

Kelly Abbrescia, DO

Dr. Kelly Abbrescia was headed toward a career in surgery when, in her third year of medical school, she rotated through the emergency room. “‘This is it,’ I thought. ‘This is my life,’” Abbrescia says.

Even now, as medical director of the emergency department for Bayhealth, a job with a large administrative component, she works 9- to 12-hour shifts in the emergency room of Kent General Hospital, treating everything from dental pain to gunshot wounds, with everything from colds and flus to injuries from car accidents to heart attacks and strokes in between. “You never know what’s coming next,” says Abbrescia. “One minute, you’re holding a new baby. The next, you have to run into another room to treat a trauma.”

With 30 emergency-medicine physicians on staff, including trauma and surgical specialists, Kent General, Milford Memorial and Bayhealth’s new emergency facility in Smyrna can handle anything that their 100,000 patients present each year. “With each patient, I’m like a detective,” Abbrescia says. “You have to know what to do, how to treat. You have to be able to do it all.”

Physicians and nurses also staff temporary facilities during NASCAR races at Dover International Speedway, where they’ve treated women in labor, and during big concerts, such as the Firefly Music Festival, where they treated 3,500 patients last summer for twisted ankles, heat stroke, alcohol poisoning, drug overdoses and other issues. “Pretty much none of us go on vacation during those weeks,” she says.

The attributes that serve her best: a cool head and tact. “You’ve got to stay calm and in control,” Abbrescia says. “And you’ve got to be personable. You’re meeting people who are sick and afraid, and you need to comfort them.”

Her work also requires staying up to date on the latest treatments and advances in many medical specialties. “Emergency medicine has given me a perspective on life and death,” says Abbrescia, the mother of three teens. “I truly appreciate life, the beautiful things and the terrifying. It changes your personality so that you truly live in the moment.”

Nathan A. Merriman, MD

One of the complications of antibiotic therapy for killing bacteria that make you sick is the collateral killing of bacteria that keep you healthy. Your gut is full of them, so-called beneficial bugs that aid in the digestion of your food. When they die en masse, your body revolts, often in the form of recurring diarrhea and cramping.

Treating one dangerous condition, Clostridium Difficile colitis infection, with fecal transplantation through endoscopy has helped gastroenterologists like Dr. Nate Merriman better understand how the various bacteria and viruses in each person’s digestive tract interact, and how the patterns of interaction translate into groups of patients with similar symptoms and illnesses.

Among those symptoms, count the villain commonly known as irritable bowel syndrome, a catch-all for conditions of the colon ranging from bloating and gas to constipation to cramping.

“I have tried to work with patients to help classify their dominant symptoms into specific irritable bowel symptom subtypes,” Merriman says. “This has helped me to better understand how food choices and daily activity patterns are interacting with and affecting each person’s gastrointestinal symptoms.”

Among the most common causes of IBS are poor diet and stress, and they walk hand in hand. Overwhelming stress can mobilize sugars that, when digested, break down into foods that bad bacteria thrive on. Roughly stated, more bad bacteria equals more potential for illness. Factor in convenience feeding on foods of dubious nutritional value.

“We’re not thinking, ‘I need to balance each meal,’” Merriman says. “I advocate for balance and moderation.”

The key to successful treatment of IBS-related symptoms lies in learning which bugs to replace, which bugs to use as replacements and the proper pro- portions, based on each person’s unique microbiome and genetics, Merriman says. The goal: more focus on the prediction and prevention of unpleasant or dangerous conditions.

Adam Raben, MD

Radiation oncologist Adam Raben has a special expertise in three areas of cancer research and treatment: prostate cancer, melanomas, and head and neck cancer. Among the last, he is keenly interested in tumors caused by human papillomavirus.

HPV describes a group of more than 200 related viruses, 40 of them transmitted through sex. Of those 40, about a dozen are high-risk viruses that have been linked to cancers of the cervix, anus and throat. According to the National Cancer Institute, almost all incidences of cervical cancer and 95 percent of anal cancers are caused by an HPV type. About 70 percent of cancers of the tonsil, base of tongue and soft palate are caused by HPV.

Raben points out that such throat cancers are essentially different than cancers caused by smoking. HPV inserts itself into normal cells, where it switches off a gene that suppresses cell growth. The result: malignant tumors, even in cases where the virus was cleared many years before. Molecular diagnostics and genetic profiling have thus become important tools in identifying specific cancer types and focusing treatment.

HPV vaccinations are “a game changer” for cancer prevention, Raben says. Though the incidence of HPV-caused cancers are on the rise in Delaware and across the country, he expects rates to tail off in 15 to 20 years as vaccinations such as Gardasil become common. In the meantime, he and a team of specialists at the Helen F. Graham Cancer Center and Research Institute in Newark remain in national clinical trials to find the best treatments. Raben is involved in review and design of those trials through the National Cancer Institute steering committee.

Raben is also concerned about the rise of obesity-related cancers in Delaware. The link between obesity and cancer is well known, but there is another problem: Obesity can hinder cancer treatment. The Graham Center was forced to buy a larger-bore CAT scanner because many patients didn’t fit into the older model. Morbidly obese patients are poor candidates for surgery and, sometimes, chemotherapy or immunotherapy, and their extra tissue makes it difficult to focus radiation effectively. What’s more, “If the cancer is aggressive, they don’t have time to lose weight,” Raben says. “That’s incredibly problematic.”

Rachel Smith, DO

There is no question about the complaints Dr. Rachel Smith hears most: pain in the neck and lower back. Throw in some aches from some sports injuries and arthritis, but, “Spine issues are the prime reason people see us,” Smith says.

The main culprits are lumbar spinal stenosis and herniated discs. Stenosis describes a crushing of the nerves. It is most common, but not exclusive, among the elderly. Herniations can mean anything from a tear in the shock-absorbing discs between vertebrae to a rupture. They can result from injury or repetitive trauma.

“Unfortunately, where the pain is doesn’t always tell us the cause,” Smith says. Pain in the leg, for instance, can result from nerve damage in the spine. Discussing the pain with the patient is therefore a large part of the diagnosis. Making time to let that happen is vitally important.

To treat, Smith favors “conservative” approaches first. Stretching and exercise can relieve some symptoms. In some cases, so can weight loss. Chiropractice, massage and acupuncture, or some combination of them—can also be effective. More aggressive treatment could include injections of steroids or numbing medications. The worse-case treatment is surgery, though only 2 percent to 5 percent of her spine patients require it, Smith estimates.

Though pain relief is the goal, “Treatment doesn’t mean people will always be pain free,” Smith says. About 55 percent of recurring back problems increase with age. Sometimes pain management and increased functionality are the best result to be hoped for.

The moral: When you start hurting, seek help right away. “When people have physical conditions, taking responsibility to help oneself is very important,” Smith says.

Valerie A. West, MD

As an endocrinologist, Dr. Valerie A. West treats many of her patients for conditions or diseases of the thyroid, pituitary and other glands. Broadly speaking, hormones released by the first regulate growth and metabolism. Hormones released by the pituitary affect some functions of the thyroid, plus blood pressure and some reproductive functions.

West treats everything from hypoactive thyroid, which causes fatigue and other symptoms in adults and can stunt the growth of children, to hyperactive thyroid, which causes irritability. She also treats tumors of the pituitary and the thyroid—which recently emerged as one of the top 10 cancers for the first time. She also deals frequently with the conditions of age-related reduction of hormones, such as osteoporosis resulting from lower levels of estrogen in post-menopausal women.

But the issue that concerns her most is diabetes, which reached epidemic status in the United States a few years ago. “The incidence of Type II diabetes now exceeds Type I in children for the first time,” West says. In Delaware, with a rate of obesity approaching that of the notoriously high Southern states, diabetes is still a growing health issue. Blame stress, poor diet and a sedentary lifestyle for the surge in Type II—late-onset—diabetes. “Two-thirds of Americans are overweight,” West notes.

Diabetes, whether acquired in childhood or as an adult, describes high blood sugar due to low production of insulin and-or the body’s inability to respond correctly to insulin. Unmanaged, diabetes can result in nerve disorders, lowered immunity, blindness, kidney failure, cardio- vascular disease and worse. The worst cases require insulin injections. Others can be managed with medication. Best yet, some cases can be reversed by exercise and good eating. West notes that many insurance plans now cover the cost of consultations with dietitians. “You can’t underestimate the importance of good food,” West says.

David M. Cohen, MD

As a society, we travel more than ever, which has resulted in more cosmopolitan tastes and an appetite for foods such as sushi. We return home more willing to take risks with our eating and, sometimes, bearing a few alien bugs.

So when you feel sick in a way you’ve never felt before, it often takes an infectious disease physician like David Cohen to sleuth out the cause and determine the proper treatment. “It’s an awfully exciting field, a very diverse field,” Cohen says. “We see a lot of different things.”

Viruses and bacteria migrate with human and animal populations. It doesn’t take long for a disease such as West Nile virus, for example to spread from its place of origin in Uganda to North America via human travelers and mosquitoes. That’s not to mention equally insidious diseases such as Lyme or ehrlichia, both borne by ticks, that have originated in the United States.

Then there are illnesses acquired via lifestyle choices. Eating sushi, carpaccio or any other raw or undercooked food means rolling the dice with bacteria. Intravenous drug use and unprotected sex can lead to HIV infection—still a major public health issue in Delaware, which has one of the highest per capita number of cases. Factor in advancing age and complications such as diabetes or cardiovascular disease, and infection becomes something more serious.

The good news: new molecular diagnostic tools that allow fast identification of viruses and bacteria, a vast improvement over the time-consuming process of culturing bugs in a lab—time that could be spent on treatment instead of time for infections to spread.

The big emphasis: good antibiotic stewardship. With so many bugs mutating rapidly toward resistance to medication, the trend is toward avoiding prescriptions and, when necessary, the shortest possible course of treatment.

“Partnering with your primary caregiver is the best way to be healthy,” Cohen says. Plan all vaccinations, especially before travel, he says, and avoid risks for chronic disease. “Those who stay informed make the best patients, and the best patients often experience the best outcomes.”

Top Doctors 2015 (Complete List)

Top Doctors Criteria: On May 21, a questionnaire was mailed to 1,500 Delaware-based, licensed physicians listed in the “Little Blue Book.” The reference was suggested by a past president of the Delaware Medical Society as the most inclusive list available and the source doctors use to find others. Our survey asked physicians who they would recommend to a loved one. Only licensed doctors were permitted to respond. They were allowed to nominate up to three physicians in each category. About 200 questionnaires were received. No doctor is included in the list because he or she advertises in Delaware Today or any of its related titles.

The List—Doctors’ Choice • The doctors who received the greatest number of votes in their specialties are listed in bold. Addresses and phone numbers are for main offices. Doctors may have others.