Dr. Valerie West sees about 15 patients a day, and she enjoys spending a good deal of time with each one. “An endocrine history usually tells you more than a physical exam,” she says, “but, of course, you do both.”
Endocrinology is the area of medicine that deals with glands, which secrete hormones, which regulate everything from growth to metabolism to reproduction. Gland disorders can lead to such conditions as osteoprosis and diabetes.
Osteoporosis is characterized by a decrease in bone mass and density, causing bones to become fragile. West often treats osteoporosis with oral bisphosthonate medicines such as Fosomax, Actonel and Boneva, which slow bone loss. She’ll sometimes prescribe Reclast, a new intravenous drug that helps people who can’t tolerate pills. A stronger drug, Forteo, actually builds bone.
Why wouldn’t every patient want Forteo? Three reasons, says West. It requires an injection daily for one to two years. It costs a fortune if not covered by insurance. And the FDA has found, in studies of rats, there’s an increase in a rare bone cancer. “So far in people, that does not appear to be the case,” West says. But Forteo is still risky.
West is known for sincerity and patience. Diabetic adults need encouragement, not lectures. “Education is crucial,” she says. “Some things are difficult, like suggesting a healthy lifestyle change, but if patients understand what they have to gain from it—which is what I want to learn from my own physician—it’s more meaningful.
“With diabetes, the payoffs of getting good control are phenomenal, including decreased complications like kidney, eye and nerve problems, better immune function. And when sugars levels are corrected, people have more energy and can see better,” says West.
Osteoporosis is fairly common, and diabetes has reached a near-epidemic scale. But West is busiest tending to thyroid disorders and thyroid cancer. Hyperthyroidism (over-active thyroid) can cause a stroke or a heart attack. With hypothyroidism (under-active), patients can lose focus, feel cold or gain weight. Incidences of thyroid cancer, unfortunately, are on the rise. “It’s a national problem, though it’s true that Delaware is still among the top in cancer ratings,” says West. “You can wonder about all the chemicals here, but it’s speculation at best.”
Her suggestion “Do an exercise that’s enjoyable, easy and adaptable.”
West’s resources They include her fellow board-certified endocrinologists at The Diabetic Center at Christiana Hospital, which offers specialized care for patients with diabetes, metabolic issues and other endocrine disorders.
Page 2: Adolescent Medicine | Lisa Barkley, MD
It takes a specialist—and a special person—to understand the physical and mental changes that occur during adolescence. You might say that Dr. Lisa Barkley, a specialist in Christiana Care’s Adolescent Medicine department and medical director at Delaware State University, starts where pediatricians leave off.
Adolescent medicine specialists focus on the physical, psychological, social, and sexual development of adolescents and young adults. Barkley focuses on teens, helping them transition to adulthood. The teen years involve more physical and mental changes than any other stage of life except the first year. “Making a successful transition into adulthood is crucial to future adult health and greatly influences the workforce and childbearing years,” Barkley says. “It’s rewarding to know that your work can positively impact the trajectory of a young person’s life.”
During the first visit, Barkley does a physical exam after creating a comprehensive patient history. “I then have an age-appropriate discussion of the problem and come up with a collaborative action plan to address the issue, utilizing positive support people for the teen,” she says.
The key to her success is special interviewing techniques that make teens feel comfortable and help to develop trust. “In our very technical society, few people really talk to them,” Barkley says. “I find that kids enjoy talking to an adult who cares and gives them accurate information on how to be healthy. But I’m also mindful of not being judgmental.”
Barkley calls teenagers “one of the most underserved and misunderstood populations in the country.” Between 1995 and 2005, suicide was the second leading cause of death for youths and young adults in Delaware, according to the Delaware Health Statistics Center. Risk factors included depression or other mental illness, substance abuse, stressful life events or losses, and access to lethal weapons. But Barkley cites a recent study by the National Institute of Health that says that after years of significant rises in teen suicide, as well as homicide, motor vehicle deaths and STDs, rates have started to level off.
“I am continually amazed by the complexity and enormity of the problems that many of our young people face across all economic and racial boundaries,” Barkley says. She hopes more research into brain development will lead to better support systems for teens.
Teens’ biggest hurdles Relationship problems, depression, eating disorders and menstrual disorders. “Sexually transmitted infections and substance abuse are particularly significant problems.”
Advice to parents “First, encourage teens to stay involved in addressing the problem, even when they object to your input. Second, talk to your doctor about the problem so that medical issues can be uncovered, if present, and you can get referrals for more intensive help.”
Page 3: Obstetrics-Gynecology | Vincent B. Kileen, MD
Dr. Vincent B. Killeen may deliver 1,000 babies a year, but to him, birth is still a miracle.
“When I deliver a baby, I can look at those two partners and explain everything medically, from the head crowning to the first cry,” he says. “But there’s still that magical moment when you sit back in awe and say, ‘How does that happen?’”
Killeen treats women of all ages at Bayside Health Association, where he and partner Dr. Steven Berlin have earned national reputations for laparoscopic surgeries, mostly hysterectomies.
“We have one of the largest studies, well over 350 laparoscopic hysterectomies to date that we’ve performed successfully,” says Killeen. The study compares the cost of traditional and laparoscopic hysterectomies. Performed as outpatient procedures, laparoscopic surgeries take less time, with less expense to the hospital and far less recovery time for patients.
Killeen is the father of three daughters, so his professional philosophy is a personal one. “I want women to be competitive at the same level, without medical excuses dragging them down. I want my kids, and all my patients, to command a room. This type of surgery lets them undergo major surgery and be back working way in advance of what society expects them to be.”
For the perimenopausal or menopausal woman, Killeen says judicious hormone replacement therapy is “the front line medicine.” He prefers plant- or peanut-based offerings such as Enjuvia or Prometrium.
inner voice Listen to it. “If something hurts, there’s a reason. Don’t come to my office eight months after finding a lump. Your body’s not stupid. Nature is not stupid.”
To your health “We know what to do. We just have to do it. Watch your weight. Exercise. Please don’t smoke. Get those tests done.”
Don’t fear the GYN “My sole reason for being here is to positively impact my patients’ healthcare. That cuts across every female type—pregnant, not pregnant, married or single, young or older. Women are women. I want them to think of me as their advocate.”
Page 4: Oncology | Gregory A. Masters, MD, David D. Biggs, MD
Doctors Gregory A. Masters and David Biggs are two of several respected board-certified oncologists at the Helen F. Graham Cancer Center at Christiana Hospital. Biggs’ sub-specialty is breast cancer. Masters concentrates on lung cancer.
“In our group, we like for each person to have a sub-specialty to get increased experience and expertise in a particular area,” says Masters. “Communication between the specialists helps ensure better and, often, less costly care. We don’t reorder the same tests, we get our recommendations coordinated, and we can present a plan to the patient in a more cohesive form.”
Nationally, breast cancer causes about 45,000 deaths a year. Lung cancer causes about 80,000. Both men earned national reputations for coordinating clinical trials. Masters co-chairs a group that analyzes the effectiveness of combined chemotherapy and radiation on patients with small-cell lung cancer. Biggs, chief of oncology at Christiana, coordinates studies for The National Surgical Adjuvant Breast and Bowel Project, which studies treatments for breast cancer. The doctors enjoy offices in the newest section of the Graham Center, where a recent expansion nearly tripled its size. The center boasts Delaware’s first dedicated breast MRI scanner and offers advanced radiation therapies.
Biggs on Masters “Greg came here with an established reputation and is recognized throughout the country. He’s calm and unflappable and never shows any stress. That’s important when dealing with patients who may be, understandably, stressed out.”
Masters on Biggs “Dave is knowledgeable and scholarly, but not too formal. He has compassion. There’s lots of stress and a lot of unknowns in cancer treatment. While Dave knows the facts, he can distill them to a level that patients understand.”
Biggs on exercise “Patients who exercise more and are closer to their ideal body weight—and don’t smoke—have much lower incidences of cancer.”
Masters on smoking Starting to smoke at any age will plant a seed that could lead to lung cancer. Don’t do it.
Page 5: Allergy-Immunology | Gregory Marcotte, MD
Delaware is highly industrialized, so “pollution from fossil fuel creates ozone, nitrogen dioxide, sulfur dioxide and particulate matter that can exacerbate asthma, hay fever and sinus disease,” says Dr. Gregory Marcotte of Wilmington. “And the greenhouse gases we hear about that are raising the global temperatures? Plants breathe CO2 and like warmth, and studies have shown that higher CO2 levels and warmer temperatures induce plants to produce more pollen.”
It’s a vicious cycle that means asthma, allergy and sinus sufferers are in big trouble. “I don’t have to convince my patients that we have more than enough pollen in Delaware,” Marcotte says. “We also are already on the EPA’s naughty list for having unsafe levels of ozone and particulate matter, as well as high levels of air toxins that can be carcinogens.”
So Marcotte takes a three-pronged approach to allergic diseases and food allergies: Identify allergens, show patients how to avoid them, then treat with medication. If that doesn’t work, he’ll suggest allergy shots every two to four weeks for three to five years. Because a body can build immunity, many can eventually stop the shots and decrease medication—some entirely.
Marcotte designed his office to make life more bearable for patients. To discourage dust mites, he replaced carpet with bamboo flooring and upholstered chairs with vinyl. He also used locally made products to decrease pollution from shipping. Everyone can breathe easier.
Beware of big words Allergy reaction-inducing foods such as eggs and nuts can be hard to identify on food packages, so be careful. Ovalbumin is another word for egg. Casein is a milk protein. Miso means soy. The FDA mandated that labels be simplified in 2006, but the big words still appear.
Costly Comfort Allergy medicine can be expensive. Antihistamines such as Claritin have jumped over the counter, but still cost more than a dollar a day. Steroid nasal sprays such as Flonase or Veramyst remain the standard, but they are available only by prescription.
Always ask about your food Why did Marcotte’s peanut-allergic young patient have such a severe reaction to a bowl of chili? It was thickened with a secret ingredient: peanut butter. Always ask the cook.
Page 6: Pain Management | Rachael Smith, DO
Construction workers, teachers and police officers tend to walk, bend, stand for hours and lift heavy objects. That can hurt. But severe pain can be debilitating to anyone, no matter what they do for a living or their age. So you don’t need to do manual labor to need a pain management specialist such as Dr. Rachael Smith of Delaware Back Pain and Sports Rehabilitation Centers.
“People will try to ice conditions or buy over-the-counter medications,” says Smith. “But when things progress, they’ll go to a family doctor or an orthopedic specialist. When things still don’t get any better, they come to us.”
Many patients develop serious back and neck damage from lifting the wrong way. Have a desk job? A recent study by the Occupational Safety and Health Administration found that more than half of the workers who used computers at least 15 hours a week reported musculoskeletal problems in the first year of a new job. Attribute some of those injuries to non-ergonomic chairs, which can place uneven pressure on the vertebrae and disks of the lower back.
The field of pain management is as broad as it sounds. “We manage various muscular and skeletal issues, as well as athletic and shoulder injuries, tendonitis or carpal tunnel syndrome,” says Smith. “We also find ways to prevent surgery or guide patients to a surgeon when appropriate.”
Pain can often be managed without surgery. Smith specializes in spinal injections, or shots of anesthetic in various areas of the spine to control pain elsewhere in the body. The shots have existed for decades, but “the way we’re doing them has changed,” Smith says. “Since more people are learning that this is one of the best ways to treat back pain, the training is more focused in this direction.”
Smith takes a multi-disciplinary, individualized approach. “We could develop a good rehabilitation program, arrange for chiropractic help or do various tests,” she says. “Medications are prescribed, and injections are done when necessary, but we treat the whole person and get them better based on evidence and guidelines.”
Can anyone be completely pain free? No one can say. But Smith’s goal is to get patients “to a place where they’re not hurting.”
The common complaints In order: back and neck pain, sciatic problems, and knee and shoulder pain.
Doctor’s orders Exercise regularly, eat right and stay at a good weight. “We know that being overweight can aggravate back and knee conditions,” says Smith. “Flexibility and stretching exercises prescribed by specialists can alleviate arthritic conditions, too.”