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 October 2014

October 2014

 

           
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Doctors Doing Their Best

Peer-honored physicians discuss medical breakthroughs, including botox shots, bionic pancreases, DMARDs, and eye inejctions.

Lawrence Dickinson, M.D., Nuerosurgery, Pacific Brain & Spine Medical Group, Castro Valley.

Lawrence Dickinson, M.D., Nuerosurgery, Pacific Brain & Spine Medical Group, Castro Valley.

Pat Mazzera

 

As residents of the East Bay, we not only live in a beautiful and diverse area, but we also have access to some of the nation’s top-ranked physicians. Yet even drawing from a large pool of talented and experienced medical professionals, finding a doctor who takes your specific insurance plan, has the right qualifications, and offers a good bedside manner can prove to be a challenge. 

The staff at Best Doctors Inc., a Boston-based organization that conducts a massive, continuous independent study of the medical profession, can help take the guesswork out of choosing a qualified specialist. The doctors on the annual list are named through a peer-to-peer process where physicians are asked, “If you or a loved one needed a doctor in your specialty, to whom would you refer them?”

Doctors cannot pay to be on the list or vote for themselves. In addition, the staff at Best Doctors reviews each physician nominee for current licensure, board certification, and any malpractice suits, as well as their specific expertise, including special research and published works. All of the doctors listed are chosen not just for their résumés, but also for their continued clinical prowess and their interpersonal skills.

This year, we chose five outstanding doctors to profile from the list of 249 physicians identified by Best Doctors Inc. Spanning a wide range of specialties including pediatrics, neurosurgery, and endocrinology, this list offers a guide to some of the finest medical care the East Bay has to offer.

 

Christine Aguilar, M.D.

Pediatric Rehabilitation

UCSF Benioff Children’s Hospital Oakland

A pediatric rehabilitation specialist who works with children diagnosed with brain and spinal cord injuries and conditions including cerebral palsy and spina bifida, Aguilar realized early in her medical training that she wanted to work with children. A Northern California native, Aguilar attended medical school at the University of California, San Diego School of Medicine, and went on to complete a residency at the UC Davis Medical Center and an internship at UCSF Medical Center. A married mother of two grown children, Aguilar, 56, is an avid runner and lives in the East Bay.

What types of cases do you primarily see as a pediatric rehabilitation specialist? 

We treat a lot of children who have sustained traumatic brain injuries in automobile accidents, as well as patients with cerebral palsy and brain infections. We have an excellent team of physical, occupational, and speech therapists that work closely with families, and recently added art and music therapy to our program. 

How has the field of pediatric rehabilitation evolved since you began working at Children’s in 1995?

Over the past 10 years, we have seen the use of Botox injections shift from wrinkle reduction to successfully treating muscle spasticity in children with cerebral palsy. Children with CP have very tight muscles, which get even tighter as the child grows, and most need multiple surgeries to lengthen their muscles. Botox can help us to avoid or decrease the number of surgeries and can also help many children walk.

You recently added a therapy dog to the rehabilitation program at Children’s. Can you tell us more about that?

Yes, Trinity, a 2-year-old yellow Labrador retriever, is our Canine Companion facility dog and she lives with my family and accompanies me to work at the hospital each day. She joined our staff in May and works closely with our physical and occupational therapists. Trinity has been professionally trained and can perform over 40 commands designed to motivate patients with special medical rehabilitation needs. She also provides comfort and unconditional love to our patients and inspires our pediatric patients who are overcoming physical and cognitive challenges. 

You became a runner several years ago and have gone on to participate in several races. How did you start a running routine?

When I was in my 20s, I said I wanted to complete a marathon by the time I turned 50. That didn’t happen, but when I turned 52, I set out to lose some weight and decided to give running a shot. I started walking on the treadmill, and worked my way up to running three miles. I competed in my first race with a friend. Since then, I’ve gone on to compete in five marathons. I’m not a super-fast runner, but I think that’s one of the advantages of becoming a runner later in life—I realize I’m probably not going to win, so I enjoy the race.

 

Yvette Fan, M.D

Pediatric Endocrinology

Kaiser Permanente Medical Center, Oakland

A mother of two, Fan attended medical school at the University of Arizona College of Medicine, before coming to Kaiser Permanente Medical Center in Oakland to finish her residency. After completing a fellowship at Stanford University’s School of Medicine, Fan returned to Kaiser Permanente’s Oakland Medical Center and has worked for the Permanente Medical Group as a pediatric endocrinologist since 1997. In her spare time, Fan, 49, enjoys hiking, scrapbooking, and kickboxing. She lives in the East Bay with her husband and two teenagers.

What types of cases do you see in your practice?

I treat children with a variety of conditions, including growth issues, type 1 and type 2 diabetes, and thyroid conditions. With childhood obesity, we work with the children and a dietitian to try and get their diet and weight under control. We also work with children who are pre-diabetic to help them lose weight and avoid having their condition progress to type 2 diabetes. It’s very rewarding to work with so many families, such as our diabetic patients, over a period of years, and to watch them live full lives and not let their medical condition define them.

How has the practice evolved over the past 16 years?

We’re seeing more children who are going through puberty at an earlier age and have also seen the rates of childhood obesity and type 2 diabetes rise rapidly among children. When I was doing my fellowship, I typically would only see one to two children with diabetes, and now that population makes up a third of my practice. Over the last couple of years, we’ve also seen a rise in the number of transgender kids that we treat. They now make up 5 percent of my practice, or about 15 to 20 children and teens, but five years ago, we had none.

Are there any cases in particular that have impacted the way you practice medicine?

One of my patients is an 11-year-old who has a rare genetic disease called Wolfram syndrome that caused him to develop diabetes at the age of 2 and will gradually rob him of his sight and hearing as a young adult. His family organizes a team every year to run in the Oakland Running Festival to raise money for research for a cure for Wolfram syndrome. Initially I started running the 5K, and each year I’ve doubled the distance that I run. This year I will be running the half marathon. For those who know me, I am incredibly uncoordinated and unathletic, so for me to run any kind of race is a huge deal. I’m not a researcher, so while I can’t find a cure for diabetes, I can care for my patients, educate others about how diabetes affects our lives, and raise money for awareness and research.

How has technology changed your practice?

Continuous glucose monitoring and insulin pumps have really evolved, and they help our diabetic patients to better manage their blood sugar levels. A bionic pancreas is already being tested—it checks a person’s blood sugar level, using a little sensor that goes just under the skin, every five minutes, and it sends this information to a Smartphone app that then “decides” whether blood sugar needs to be raised or lowered and automatically administers insulin as needed. It’s already been successfully tested on adults and teens with type 1 diabetes, and I believe it will be approved by the FDA and available to consumers within the next 10 years.

 

James Lahey, M.D.

Ophthalmology

Kaiser Permanente, Union City Medical Offices

Growing up in Southern California, Lahey originally set his sights on being a bass player. Although he decided to ultimately pursue a career in medicine, Lahey continues to play the bass and to write original music. A graduate of University of Texas Health Science Center School of Medicine in San Antonio, Lahey came to the Bay Area to complete his internship at St. Mary’s Hospital and Medical Center in San Francisco, and his residency at UCSF. He also completed a fellowship at UCLA Medical Center before joining Kaiser Permanente in 1993. Lahey, 54, is the father of three grown sons and lives with his girlfriend in the East Bay.

You recently went on a medical mission. Can you tell us more about that experience?

Last year, I traveled to Nepal in South Asia for four weeks to perform retinal surgery. Nepal is one of the poorest countries in the world, and their hospitals don’t have the equipment that we have here in the United States. It’s also not uncommon for the power to frequently go out in Nepal, so we were working under very different conditions. People would travel for miles and line up waiting to be seen. We treated cases of retinal detachment, eye complications caused by uncontrolled diabetes, and operations for cataracts and glaucoma. It was a phenomenal experience and I hope to return, but the mission also made me even more appreciative of my practice here at Kaiser Permanente.

What advancements have you seen in the field of ophthalmology?

The field of retinal surgery has advanced dramatically in recent years. It’s very exciting to have so many new treatments to offer to our patients. We now have eye injections that we can offer to patients to combat the wet form of macular degeneration, the most common cause of vision loss, affecting one in five people over the age of 70. Until recently there was no medication available to treat macular degeneration, and they would lose their eyesight. While these injections aren’t a cure, they do allow people with the most severe form of the disease to maintain their sight longer.

What’s the most rewarding aspect of your job?

I enjoy being able to help patients overcome any challenges they might be having with their eyesight and to get the highest-quality vision. My philosophy is to treat each patient’s problem as I would want to be treated if a family member or myself had the same problem. At Kaiser Permanente, there is no financial reward for choosing a certain treatment pathway, so I can recommend the course of treatment that I believe will offer my patients the greatest impact.

What vision advice do you have for readers?

Many vision problems such as macular degeneration and cataracts are best treated in their early stages. In order to maintain long-term eye health, we recommend that patients under 40 have their eyes examined every two to four years, after the age of 40, patients should get an eye exam every two to three years, and every year after the age of 60. By getting regular eye exams, an ophthalmologist can detect whether you have macular edema, cataracts, or diabetic retinopathy (a diabetic eye disease), and can work with you on a treatment plan to preserve your vision.

 

Lawrence Dickinson, M.D.

Neurosurgery

Pacific Brain & Spine Medical Group, Castro Valle

A native of Southern California, Dickinson received his medical degree from the University of Southern California, before completing a seven-year residency in neurological surgery at the University of Michigan, and a fellowship in cerebrovascular surgery from the University of Florida. After completing his fellowship, Dickinson returned to Michigan and served as assistant professor of neurosurgery at the University of Michigan for six years. In 1998, he moved to the East Bay to join the Pacific Brain & Spine Medical Group. A resident of San Ramon, Dickinson, 55, is a married father of two college-aged children and enjoys surfing, snowboarding, and traveling.

How did you choose neurological surgery as a medical specialty?

I originally wanted to be an astrophysicist, but in my third year of college, I changed to biophysics. When I was in college, my sister died from head injuries sustained in a car accident, and just as I was applying to medical school, my brother was hit by a drunk driver, sustained severe head injuries, and later died. The experience of losing two family members had a huge impact on my entire family. My mother became very involved with the Los Angeles chapter of Mothers Against Drunk Driving, and I decided to become a neurological surgeon, in part to help patients who had sustained brain injuries and their families.

Do you think your family’s experience has altered the way you interact with patients?

I believe that I have more empathy for patients and their families having gone through the experience of having a loved one with a head injury. The physician who treated my brother had an awful bedside manner, and I vowed to never be like that. My mentor in medical school was a saint of a man who taught us the importance of having compassion in our practice. He wouldn’t allow us to be egomaniacs. When a patient suffers a brain injury, the entire family is affected, and it’s part of our job as doctors to educate families and to help them become better caregivers. For this reason, I think it behooves physicians to become better communicators.

What types of cases do you see in your practice?

At Eden Medical Center in Castro Valley, where I practice [surgery], we provide trauma care for the southern and southeastern part of Alameda County. We treat patients with traumatic brain injuries, concussions, brain aneurysms, spinal cord injuries, strokes, and brain tumors. We also provide care to the Oakland Raiders, so if a member of the team, or an opposing NFL team, receives a head injury during a home football game, we treat them.

How has your practice changed over the years?

When cars didn’t come with airbags, we used to see a lot more cases of traumatic brain injuries. Today, we see a lot of concussions resulting from sports injuries. We use the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) program, the same program used by the NFL, as the standard for computerized concussion evaluation. We work with high school teams in Castro Valley to give athletes a baseline ImPACT test, and then after a player is injured, we evaluate their injury, repeat the ImPACT test at the clinic, and compare the results with their baseline test results. This helps us to manage their recovery from the concussion and ensures they don’t return to the game too soon.

 

Magnano, M.D.

Rheumatology

Sutter East Bay Medical Foundation, Berkeley

After attending medical school at Stritch School of Medicine at Loyola University Chicago, Magnano, 39, moved to California to complete her internship, residency, and fellowship at Stanford University’s School of Medicine. It was there that Magnano became interested in rheumatology, a medical subspecialty that diagnoses, manages, and treats patients with conditions including osteoarthritis and joint pain, as well as autoimmune diseases including rheumatoid arthritis, gout, and lupus. Magnano, a married mother of three children, lives in San Francisco and enjoys reading, running, and playing tennis in her spare time. 

How did you choose rheumatology as a specialty area?

I first became interested in the field during my residency at Stanford. Many autoimmune diseases, including lupus and rheumatoid arthritis, are still misunderstood and misdiagnosed. Often my patients have seen several doctors and received different diagnoses since the symptoms of autoimmune diseases can mimic those of many other conditions. I enjoy diagnostic challenges and helping patients to get an accurate diagnosis and then working with them to devise a treatment plan that helps them live well.

The Centers for Disease Control and Prevention estimate that by the year 2030, 70 million Americans will be at risk for osteoarthritis. What advice do you have for readers who may be looking to ease or alleviate arthritis pain?

I recommend that people with osteoarthritis start by maintaining a healthy body weight. Several studies have shown that patients who lost weight but received no other treatments for knee osteoarthritis experienced improvements in quality of life, the ability to perform day-to-day tasks, and their capacity to participate in sports activities. I also recommend doing some kind of strength training. Even working out with light weights can help reduce soreness, stiffness, and pain. For many people, exercising with arthritis seems counterintuitive, but if I can talk someone into exercising two to three times a week, they usually see a big difference in their pain and stiffness and become believers in the benefits of exercise.

What advancements have been made in the field of rheumatoid arthritis since you first began practicing medicine?

Many medications such as disease-modifying antirheumatic drugs—referred to as DMARDs—have greatly improved outcomes for patients with rheumatoid arthritis by decreasing pain and inflammation. For most people with RA, early treatment can control joint pain and swelling, and lessen joint damage, preventing disability, and even putting RA into remission for some patients. 

You also treat autoimmune diseases such as lupus. Have there been any significant advancements to help patients with this debilitating disease?

With improved understanding of lupus, we’ve seen an emergence of new medications in recent years. In 2011, the first lupus medication in 50 years was approved, and since then, drug development has been heating up, and we’ve seen a breakthrough with targeted therapies which are medicines directed at one little molecule in the immune system. In addition, we hope that innovative research in human tissue may also drive discovery of new therapies.

 

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