Top Doctors 2012

Search Our 583 Doctors and Nurses in 72 Specialties

Thu, 26 Jul 2012 05:00:00 -0700

Search our 583 doctors and nurses in 72 specialties

Alzheimer's: Laughter and Forgetting

Fri, 20 Jul 2012 05:00:00 -0700

When Sharon Monaghan turned 50, she got just what she wanted: a sailboat ride across Elliott Bay followed by a summer birthday bash in her own flower-filled backyard with 30 of her closest friends. Some had flown in from other states. A few hadn’t seen her in years. Sharon wore a birthday tiara. She smiled all night and told a lot of stories. Her friend Priscilla, who hadn’t visited Seattle in quite a while, noticed that Sharon told her the same story three times over the course of a few hours. No one can remember now what the story was. Maybe it had to do with Sharon’s busy hospital job; or maybe it was about Sharon and her partner Cathie Cannon’s teenage daughter, Mackenzie. But to this day, Sharon and Cathie still get a good laugh out of what Sharon said next.

Priscilla asked Sharon if she wanted to be told when she was repeating herself.

“Fuck no,” Sharon deadpanned.

What Priscilla didn’t know was that this repetition problem had been going on for months. She didn’t know that Sharon and Cathie had worked out a secret signal: If Cathie held up two fingers, that meant Sharon was telling a story for the second time. Three fingers meant it was the third time. The night of the birthday party, Cathie hadn’t always been right next to Sharon, ready to signal.

On that lush July evening in 2007, Sharon and Cathie still believed the repetition might be an aftereffect of drug therapy and radiation Sharon had undergone when she was treated for breast cancer six years earlier.

But then other, more alarming things started to happen: strange lapses in memory and judgment; odd breakdowns in the kind of problem-solving skills that were essential to Sharon’s high-octane career as administrative director of ambulatory services and primary care at Virginia Mason Medical Center and, later, as director of pain and anesthesia at Seattle Children’s Hospital.

One day in 2008, Sharon went in for neuropsychological testing. She rode her bike to work that morning, forgetting that she had planned to drive so she could get to the clinic more quickly. She took a cab to her appointment. After the tests, she was upset because she was sure she hadn’t done well. So she just started walking. She walked from Aurora Avenue in Wallingford all the way to the University District. Finally, she called a friend for a ride, since she knew that Cathie, a nurse at Harborview, would not be able to leave work to come get her. By the time her friend showed up, Sharon was beside herself, completely flummoxed by how poorly she had managed the events of the day.

Then came the terrifying moments when she suddenly didn’t know where she was. On Memorial Day weekend this year, Cathie, Sharon, and Mackenzie were hiking in the Lake Wenatchee area, near the cabin they’ve owned for 25 years. Sharon told her partner and her daughter she was scared because she didn’t recognize anything, not even the cabin, and definitely not the trail, even though they’d hiked it several times in the past. When Cathie asked Sharon where she thought they were, Sharon guessed the grassy, low-lying Magnuson Park on Lake Washington in northeast Seattle, even though they were deep in the forest with no lake in sight.

Despite the confused lapses, Sharon was so young and fit that specialists continued to theorize that medication and radiation could be to blame. There was also some speculation that she was overstressed by the demands of her job. Or maybe menopause was the culprit. But Sharon’s internist at Virginia Mason Medical Center, Minori Yoshioka, wasn’t convinced by any of those theories. Cathie remembers Dr. Yoshioka saying to Sharon: “This is just not right at your age.” In September 2009, Dr. Yoshioka ordered more neuropsychological testing, a CT scan, blood work, and, finally, a referral for a positron emission tomography (PET) scan, which would produce slicelike images of Sharon’s brain in bright primary colors, revealing how well cells in various brain regions were working by showing how actively the cells were using sugar or oxygen.

Sharon’s PET scan confirmed what the doctor had suspected, but dreaded telling her 52-year-old patient: Sharon had probable younger-onset Alzheimer’s disease, cause unknown.

Devastating news. And yet, Cathie said, it was vitally important to know, to get them going right away on a path to protect Sharon. As health care professionals, Cathie and Sharon understood the importance of jumping into action following Sharon’s diagnosis.

People with younger-onset Alzheimer’s disease are uniquely vulnerable on a number of fronts. For example, they could be fired for poor performance before a diagnosis confirms that they have a legitimate medical disability. They may not have long-term care insurance. They’re years away from eligibility for Medicare. Their children are too young to be major sources of support. Their friends are other busy middle-aged people.

Most of us think of Alzheimer’s disease as something to start fearing when we get to be about 75. But for reasons mystifying to experts, younger-onset Alzheimer’s is on the rise: At least 200,000 Americans currently living with the disease are 65 or younger. Often, like Sharon, they start experiencing symptoms before they’re 50, when they are at the height of their careers, have teenage children (Mackenzie is now 19), aging parents of their own, mortgages—every kind of financial and emotional commitment.

The umbrella term for loss of or decline in memory and other cognitive abilities is dementia, and Alzheimer’s disease is the most common type, accounting for 60 to 80 percent of cases. Alzheimer’s usually begins with a worsening ability to remember new information, followed by a gradual decline in cognitive and functional abilities. It is progressive and irreversible. It is not a normal part of aging, although age is typically the greatest risk factor. Researchers believe the development of Alzheimer’s is related to a slow buildup of proteins known as plaques and tangles in the brain.

When I spoke to Sharon and Cathie, they were about to drive down to Portland to pick up their daughter from her first year at Lewis and Clark College. “Mackenzie and I root each other on, try to be positive, do the best we can, give her all the love we can, especially when she’s grouchy,” said Cathie. She insists Sharon has always been Mackenzie’s favorite—the silly, irreverent, fun mom; “the spontaneous, joyful person who is going away and it’s hard to talk to friends about it.” When she was 25, Cathie lost her own mother to lung cancer, so she understands. Their lives are among the millions changed forever by an illness that is now routinely labeled an epidemic.

Alzheimer’s Resources

Here:Now
Art classes and gallery tours comprise the six-session class offered by the Frye Art Museum, provided free to those living with dementia and their caretakers. 206-432-8265

Alzheimer’s Association
The Western and Central Washington chapter of the Alzheimer’s Association is one of 77 chapters serving communities nationwide in a quest to eliminate Alzheimer’s disease through the advancement of research, providing and enhancing care and support for those affected, and reducing the risk of dementia through the promotion of brain health. Contact the organization regarding fundraising events, volunteer opportunities, or caregiving services. 206-363-5500

Elderwise
Elderwise focuses on enriching the lives of the elderly and those who care for them by offering programs of arts, exercise, and discussion. The $75 per day Adult Day Program meets Monday through Friday from 10am until 2pm at Horizon House on First Hill. Visit the website or call Tamara Keefe at 206-774-6606.

Alzheimer’s Cafe
The Alzheimer’s Cafe is the one of the first few in the U.S. providing an opportunity for people living with Alzheimer’s disease or other dementias and their care partners to socialize in a safe environment. This free gathering meets the second Tuesday of every month at Mae’s Phinney Ridge Cafe. Visit the website or call Carin Mack (206-297-0875) for more information.

Support Group
For those with early symptoms, the Early Stage Memory Loss group meets first Tuesdays of the month at the Greenwood Senior Center. For details, call facilitator Carin Mack at 206-297-0875. —Brandon Bye

Surprisingly, research and funding have not kept pace. Although President Obama signed the 2011 National Alzheimer’s Project Act (NAPA), mandating increased federal planning and funding, and although Alzheimer’s disease is the sixth leading cause of death and the only one of the top 10 causes still without a way to prevent, cure, or even slow its progression, Alzheimer’s research receives roughly $500 million in federal funding per year. That may sound like big bucks, but it’s one-eleventh the tax dollars that go to cancer, which affects 12 million Americans compared to Alzheimer’s current 5.4 million.

But here’s even more disturbing news: While deaths from cancer, heart disease, stroke, and HIV are all dropping, in some cases dramatically (between 2000 and 2008 heart disease decreased by 13 percent, stroke 20 percent, and HIV 29 percent), deaths from Alzheimer’s disease soared by 66 percent during the same period.

This angers Cathie Cannon. “The American public got up and yelled in the 1960s and ’70s about heart disease and cancer,” she said, and she believes it is time to do the same for younger-onset Alzheimer’s. It’s why she’s willing to share what she and Sharon are going through.

But meanwhile, there is the day-to-day work of what they’re going through, the Sisyphean slog of learning how to live with a slow and insidious illness. People who are unaffected by Alzheimer’s disease can turn away from it, bemoan its hopelessness, and toil a little harder on the crossword puzzle. They can write it off as a passive fading away. But in fact Alzheimer’s is an illness that, especially in the early stages, often triggers depression, anguish, and volatile moods. Sometimes, like a needle stuck in the groove of a vinyl record, it triggers haunting memory loops.

Sharon’s recurring loop is a pretty tough one.

During one of our meetings, she asked if I recalled the Goldmark family, murdered on Christmas Eve 1985 at their home in Madrona. Even though the event happened nearly 30 years ago, few who lived in Seattle at the time can forget that devastating loss of a prominent Seattle family. David Lewis Rice, a member of an extremist right-wing group, mistakenly believing attorney Charles Goldmark to be Jewish and Communist, bludgeoned and stabbed Goldmark, 41, his wife, Annie, 43, and their two sons Derek, 12, and Colin, 10. Annie died at the scene. The others were taken to Harborview Medical Center. Colin died soon after and Charles died 16 days later, but Derek hung on for 39 days. Sharon, then 28 years old, was the nursing manager of the neurosurgical Intensive Care Unit. When friends came to visit, it was Sharon’s job to give them an update. One boy in particular demanded to know just what she was doing to save his friend. It was tough to face his question, especially in the glare of the news media, whose interest in the case was intense. She felt drained, coming to work day after day, maintaining a calm demeanor, hiding the emotional toll.

A few minutes after she told me all of this, she brought up the Goldmarks again, as if for the first time. Again she told the story of the boy who asked her how she was going to save his mortally wounded friend.

Of all the things to have to remember. Over and over and over.

One of the reasons Sharon brought it up is because of the possible connection between her Alzheimer’s disease and the stress spikes that were an unavoidable part of her work for nearly 30 years. This connection between stress and Alzheimer’s was the focus of one of the signature studies at the University of Washington’s Alzheimer’s Disease Research Center, where Sharon is enrolled as a possible research candidate (as am I; my mother died of younger-onset Alzheimer’s in 2006, which motivated me to volunteer as a control subject).

Advancing research is vital. But quality of life is important, too. The responsibilities borne by primary caregivers to people with younger-onset Alzheimer’s disease can be overwhelming. “You can feel people pulling away,” Cathie said. “It is a very isolating illness.” But, she added, you don’t have a choice but to cope. And ask for help. And so many of their friends do really want to help. Cathie and Sharon have joined a support group, which helps them feel less alone. Sharon’s days are now carefully orchestrated by, as she put it, a “whole boatload of people.”

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Image: Young Lee

Soothed by Art The Frye’s Here:Now program helps Sharon live in the moment.

And to her great surprise, she has become an artist. I watched her work one Wednesday afternoon in the skylit studio of the Frye Art Museum on First Hill. “I love this paper,” Sharon whispered. “Because it helps hold this.” She gestured with her brush at the bright stripes of watercolor paint on her paper, which was indeed beautiful: thick, eggshell white, not too absorbent. Sharon was one of a dozen watercolorists working intently that day. The room was quiet. Teacher Tamara Keefe circulated, commenting gently on their work.

“Your color’s beautiful,” she said to Sharon. “You were just willing to see what it looked like, to see where it took you.”

Sharon was painting at the Frye as a participant in the museum’s Here:Now program. Developed in partnership with Elderwise, which offers arts enrichment programs for people with dementia, and with the regional chapter of the Alzheimer’s Association, Here:Now is a six-session class pairing conversation-based gallery tours with studio artmaking experiences for people with dementia and their care partners, now in its second year at the Frye. For Sharon, it has been a haven. Or, as she calls it, “a way to be somewhere else.” Cathie’s work schedule made it impossible for her to attend, so two friends took turns going with Sharon for six Wednesdays. None of them were quite sure what it would be like. All discovered benefits they never expected.

Sharon’s friend Mary Haskin said when it was her turn, she would look forward not only to going to the Frye with Sharon but to talking about it before and after. Here:Now became such a positive highlight in Sharon’s week that it spilled over and gave Sharon and everyone around her a huge mood lift. Mary said Cathie and Mackenzie told her that at home during the evenings after the program, “Sharon was the most clear of any time. And I think that, for Alzheimer’s patients, that is a true gift. To have that time with friends and members of the class and just have it be totally free and fun and there’s no pressure.”

University of Washington geriatrician Lee Burnside is so intrigued by Here:Now that he secured funding for a research study. His team is interviewing 50 to 70 Here:Now participants to see how many are reporting the kinds of benefits described by Sharon and her caregivers. The study will conclude in spring 2013, and, although Burnside declines to speculate in advance about results, he is very moved by the overwhelming support for Here:Now. He pointed me to a New York University study of the Meet Me at MoMA program at New York’s Museum of Modern Art, which is the acclaimed prototype for Here:Now. NYU study interviewees reported “positive changes to mood both directly after the program and in the days following the museum visit. Caregivers reported fewer emotional problems, and all but one person with dementia reported elevated mood.”

“Elevated mood” is a precious commodity for people with Alzheimer’s disease. The Frye’s waiting lists for Here:Now are so long that, if the museum had the funds, it could easily expand the program, according to Frye education director Mary Jane Knecht. She also organized a packed one-day conference called Art, Creativity, and Living with Dementia in partnership with Elderwise and the local Alzheimer’s Association chapter.

“Culturally, we’re getting there,” said Keri Pollock, communications director for the Alzheimer’s Association’s Western and Central Washington State Chapter. She praised the Frye’s 2010 conference as a catalytic event. Since then, new programs for people with dementia have been cropping up around the Puget Sound region, ranging from creative writing groups to monthly get-togethers sponsored by the Greenwood Senior Center and hosted by Mae’s Phinney Ridge Cafe.

Meanwhile, Sharon is continuing to create art through the Elderwise adult day program. It is not how she thought she’d be spending her days at this time in her life. But while the search continues for a cause and a cure for Alzheimer’s disease, Sharon and Cathie and 5.4 million more Americans and their caregivers have to get up every morning and find ways to live with an unforgiving illness.

Art—looking at it, talking about, making it—is powerful medicine, one that gives Sharon a way, however fleeting, to live peacefully in the moment, no remembering required. Even in its very name, Here:Now is all about living in the moment. Of twirling a feather in your hand after viewing and talking about a painting of a flock of ducks. Or choosing, as Sharon did, to cover one corner of her beautiful white paper with an elegant tangle of bright swirls and shapes. The rest of the page she left blank.

Top Doctors 2012

Fri, 20 Jul 2012 05:00:00 -0700

Image: Chi Birmingham

Search our 583 doctors and nurses in 72 specialties.

Seattle Met’s annual Top Doctors rankings are in. Over 4,500 doctors in the Seattle metropolitan area participated in our 2012 survey, the result of a partnership between Seattle Met and Avvo. Avvo rates and profiles 90 percent of doctors in the U.S., including every doctor in Washington state.

The 2012 survey is more comprehensive than ever, with active participation from almost 40 percent of doctors practicing in King, Kitsap, and Snohomish counties, and parts of Pierce County. Avvo’s proprietary algorithms rate doctors on a 10-point scale, employing not only peer endorsements but factors such as experience, education, training, disciplinary history, fellowships, hospital privileges, and awards. Avvo’s dynamic ratings of the 12,583 doctors in the survey area are regularly refreshed based on new information gleaned from doctors as well as from certifying and licensing boards. The doctors on the pages that follow represent the top 4 percent of practitioners in their fields as of May 2012.

For specialists not included in Avvo’s service—advanced registered nurse practitioners in nine specialties, acupuncturists, chiropractors, naturopaths, and optometrists—the rankings are based on nominations by doctors, nurses, physician’s assistants, and other health care professionals. Our survey asked those professionals to name the colleagues they would choose to treat themselves and their loved ones.

The resulting list of 583 top practitioners in their fields is presented here alphabetically by specialty. As of press time, all the top-ranked doctors and nurses were certified to practice in their fields by the Washington State Department of Health.

Seattle Met researchers gave medical professionals the opportunity to specify areas of focus within their practice or exemplary cases recently treated. For example, a doctor in the field of cardiology might list cardiovascular risk assessment, preventive cardiology, diagnostic cardiology, and cholesterol management to provide the reader with more context regarding her practice. This in no way indicates that the doctor’s practice is limited to those areas of focus.

We’ve given close attention to creating a comprehensive and detailed list, but this reference is best used as just one step in the careful journey toward finding doctors who are right for you.

Search our 583 doctors and nurses in 72 specialties.

*Footnote The following updates have been made to the Top Doctors 2012 list: Physical medicine and rehabilitation specialist Keith S. Hardy passed away and has been removed from the list. Michelle Heath, originally listed as a top internist, actually practices dermatology and has been removed from the list. Rather than at a private practice, Timothy Jacobs practices general and breast pathology at Virginia Mason. Diagnostic radiologist Peter Ory works at Highline Medical Center, not Harborview. Pediatrician Lorena Shih practices at Pediatric Associates, not Evergreen as stated. Anesthesiologist Monica Vavilala does not have a private practice (206-744-3210); she practices at UW Medicine (206-744-4371). Thomas K. Varghese is a thoracic surgeon and does not practice general surgery as we stated. Family doctor David A. Acosta is not a full-time doctor and only occasionally sees patients at UW Medicine. And family and preventive doctor William R. Phillips no longer sees patients; he is a professor who runs a fellowship program while working with medical students at UW Medicine; he has been removed from the list.

Emergency Treatment: Freestanding ERs

Fri, 20 Jul 2012 05:00:00 -0700

Image: Chi Birmingham

When a prominent Eastside community member suffered a relatively serious eye injury during a local basketball game, it seemed guaranteed that he’d spend the rest of the day in the emergency room. In Washington, the average ER visit lasts five hours. Instead, he visited one of Swedish’s Eastside freestanding ERs and was back at the gym before the game was over. “The freestanding ERs are built around a zero-wait philosophy,” says Dr. John Milne, Swedish’s vice president for medical affairs on the Eastside. “Patients are brought in and treatment is initiated right away. The average stay is 75 to 80 minutes.” Since only 6 or 7 percent of ER visits in outlying, underserved areas result in hospital stays, it is more cost effective to build standalone ERs rather than full-service hospitals. Swedish Medical Center led the way locally with the Issaquah site in 2005 and subsequent locations in Redmond and Mill Creek. MultiCare Health System opened a Covington site in April.

Research: Wiki for Brain Science

Fri, 20 Jul 2012 05:00:00 -0700

Image: Chi Birmingham

“The brain is one of our final frontiers for exploration, and it’s a very beautiful machine,” says Dr. Amy Bernard, director of structured science at the Allen Institute for Brain Science. In March 2012, Paul Allen committed an additional $300 million, bringing the total to $500 million, to further the institute’s research. Two flagship projects that map genes at work, the Human Brain and Mouse Brain atlases, are available online and free to the public. “The Allen Brain Atlas resources are like a Wikipedia of scientific information,” says Bernard. “Anyone can use our data, from a Nobel Laureate in California to a curious high school student in Uganda.” The institute’s website, brain-map.org, has been receiving about 50,000 visits a month. Since the atlases became available, Allen Institute research has contributed to studies related to possible treatments for obesity, seizure disorders, schizophrenia, Alzheimer’s, and autism. The increased funding will move the institute toward its goal of doubling its staff and expanding its research. “So much of what makes us human revolves around the brain,” says Bernard.

Patient Records: File Sharing

Fri, 20 Jul 2012 05:00:00 -0700

Image: Chi Birmingham

In 2011, Harborview Medical Center and 278 of its patients took part in a yearlong study to test a program providing online access to medical records—doctor notes, lab results, medications, and more. The program, called OpenNotes, allows patients to better engage in their own care. “We had an elderly patient whose family purchased a computer and taught her to use it just so she could participate. It helped her gain control of what she really wanted,” says Dr. Joann Elmore, Harborview Medical Center physician and OpenNotes principal investigator. Harborview was one of three national sites involved in the study. Benefits include easier sharing of information among patients, families, and caretakers, and individuals with ongoing conditions such as HIV can access frequently updated treatment details. The response was so positive that Harborview continued offering online access to trial participants after the test period ended last fall. “In the future, the majority of people said they would think about choosing a health care system or doctor based on whether an OpenNotes system was available,” says Elmore.

Pioneering Care: MS Wellness

Fri, 20 Jul 2012 05:00:00 -0700

Image: Chi Birmingham

Visitors to Swedish’s new state-of-the-art Multiple Sclerosis Center are welcomed by a flourishing affirmation of life. Live potted plants fill the lobby wall of the 11,700-square-foot facility from floor to ceiling. The $4.2 million MS Center, considered the only one of its kind in the nation, opened its doors this spring. It addresses all aspects of treating MS, a chronic disease that attacks the central nervous system and can cause symptoms from paralysis to vision loss. “It’s really trying to get to the wellness aspect and demedicalize the experience [of doctor visits],” says Dr. Jim Bowen, neurologist and MS Center medical director. Every detail was considered—wider doors to accommodate wheelchairs, no carpeting to catch toes, and a centralized layout to reduce walking for the mobility impaired. On the outside patio, a trellis covered in vining plants is outfitted with an exercise harness. The center hosts one of the largest clinical research programs in the country and a multidisciplinary team of neurologists, psychologists, social workers, and therapists. It has room enough to eventually triple its population to some 6,000 patients. “This center should be 90 percent about living your life and only 10 percent about actually seeing the docs,” says Bowen.

Natural Health: Board Certification

Fri, 20 Jul 2012 05:00:00 -0700

Image: Chi Birmingham

If you have benefited from massage therapy, acupuncture, or any form of naturopathic care, you can be thankful that you live in Washington. Our state has the most licensed naturopathic physicians (NDs) in the nation, making it a longtime leader in the field. The state legislature further guaranteed the quality and consistency of care by establishing the first-ever state Board of Naturopathy in July 2011. “The big development is this puts naturopathic medicine on par with other primary health care professionals. We’ve kind of been the stepchild, and this is a sign of greater establishment and integration,” says Robert May, ND, executive director of the Washington Association of Naturopathic Physicians. Issues regarding licensing, educational requirements, and general oversight of the profession will now be overseen by a seven-member board of NDs and citizens.

Pain Management: Military Partnerships

Fri, 20 Jul 2012 05:00:00 -0700

Image: Chi Birmingham

Sergeant Ashley Thayer, a Yakima native, joined the army in 2007 and served in Iraq and Afghanistan. In 2011, while deployed in Afghanistan, she suffered a spinal cord injury, which resulted in two back surgeries, including a spinal fusion. Her treatment at Madigan Army Medical Center’s new Interdisciplinary Pain Management Center (IPMC) in Tacoma is helping her recovery. Last year, as part of the Army Surgeon General’s campaign to improve pain management for wounded soldiers, Madigan became one of five sites throughout the U.S. and Germany to open an IPMC. In partnership with Puget Sound Veteran Affairs, Bastyr Institute, the University of Washington, and others, the IPMC offers team-based care and treatments including physical and occupational therapy, chiropractic care, health psychology, massage, and more. For Thayer, the IPMC has helped provide a better quality of life. “Even though I still have pain, I feel that I’m able to do more throughout my day than I could have before,” she says.

Philanthropy: Disco for Dollars

Fri, 20 Jul 2012 05:00:00 -0700

Image: Chi Birmingham

In July, more than 500 twenty- and thirtysomethings, along with keynote speaker Melinda Gates, gathered at McCaw Hall to party and raise money and awareness for global health. The bash was sponsored by Agency (formerly Party with a Purpose), an initiative of the Washington Global Health Alliance, and cofounded by 27-year-olds Kristen Eddings and Lacey Price. The annual event raises money through $47 ticket sales and donations amid a festive setting featuring everything from art installations and disco parties to educational exhibits and guest speakers. Past events focused on rotavirus treatments in Kenya and tuberculosis vaccine research in Haiti. Agency has earned praise as a model for engaging young adults and was recognized at the 2011 World Economic Forum. This year, the proceeds went to Mobile Moms to provide mobile phones and access to information about prenatal care to pregnant women in Timor-Leste—a Southeast Asian country with high maternal mortality rates. “The mantle has passed to us to continue the legacy of building Seattle as a center for global health,” says Eddings.