Meet 11 of our 2007 Top Doctors.
Colorado Permanente Medical Group P.C.; Neurology Department at Skyline Medical Offices, Good Samaritan, St. Joseph—Practicing for 29 years
Colorado Statistic Nearly 8,500 Coloradans suffer from multiple sclerosis, a chronic disease affecting the central nervous system. This is a higher incidence rate compared to many parts of the country.
"In Colorado, there's a higher awareness of multiple sclerosis in the medical and public community. We're in a geographic tier of heightened MS incidences. I don't think it is absolutely accurate to say we are a pocket of MS, but we see more here than if you were in the southern half of the country; the difference is significant. It's one of those diseases that's not predictable, although there is a demographic pattern to the occurrence. We most commonly see MS in young adults, typically starting in the 20s and up to the 40s. It's significantly more common in women than in men, and if there is a family history of MS. It is not a disease that is genetically transmitted, but it is partly dependent on our genes that influence the way our immune system reacts to our environment. There is nothing that has ever been shown to prevent or cure it. People hear MS and it's scary because the public image of the disease is that it's rapidly debilitating. In fact, that is a small percent of all cases. The majority of cases are relapsing/remitting, meaning that patients get a flare of symptoms and then get better, typically over weeks to months. Over time, if we can't control those episodes of inflammation, the areas of inflammation can become areas of injury in the brain and spine that can lead to persistent or worsening neurological damage. Based on MRI scans, there are episodes of inflammation that can come and go with no symptoms. A small percent of cases are progressive from the beginning; they are more difficult to control. We have a number of effective treatments to slow down the disease activity in these cases."
Symptoms Check The most common signs are blurring of vision or double vision, numbness, weakness, or uncoordination. If you have any of these symptoms without apparent cause, lasting days to weeks, then that would be a bothersome symptom."
Dermatology Associates of Colorado, Sky Ridge—Practicing for 21 years
Colorado Statistic In Colorado, the incidence of melanoma (skin cancer) is 30 percent higher than the national average.
"The question of why we have a high rate of melanoma is a good one. We see about four to six melanomas a week in our office, and the rate is rising faster here than anywhere else. It's scary. I think the biggest reason for our high incidence is, of course, the altitude. The intensity of the sun combined with 300 days of sunshine is huge. In fact, UV radiation increases 10 percent to 12 percent per 3,000 feet of altitude. But I also think our outdoorsy lifestyle is a factor. We ski, we hike, we run—and we're constantly exposed to harmful UV rays while doing it. Plus, Coloradans are a bit cavalier about sun protection—they think they're invincible. They also underestimate the amount of sun exposure you get here in Colorado just walking the dog or driving in the car. Thirdly, too many people here are still using tanning booths, which are even worse for you than regular sun exposure. And, lastly, I think we are doing a very good job of early detection. When we are seeing melanoma, we're mostly seeing stage one and stage two cancers. So, it raises our numbers, but it's actually a good thing."
Scary Thought "None of the treatments or drugs we have right now work well for deep melanoma. Give me breast cancer. Give my husband prostate cancer. But not melanoma. It's just so scary that a little black mole the size of a pencil tip can kill you."
Best Advice "Wear sunscreen every day, everywhere. Make sure your screen blocks UVA and UVB rays and has an SPF of 45 or higher."
Lutheran, St. Anthony Central—Practicing for 25 years
Colorado Statistic Colorado's breast cancer rates are 3 percent to 4 percent higher than the national rate.
"The difference between the Colorado breast cancer rates and the national average may be related to variations in breast cancer rates among different ethnic groups. Non-Hispanic Caucasian women are more likely to develop breast cancer, and there is a higher percentage of non-Hispanic Caucasian women living in Colorado. Nationally, one in eight women develops breast cancer. In Colorado, one in seven women develops breast cancer. The important thing to remember is that in Colorado the mortality rate from breast cancer is about 13 percent lower than the national average. Women here exercise, eat well, and are generally healthy. Studies say that exercise and five servings of fruits and vegetables a day reduce the likelihood of recurrence by 50 percent."
Scary Thought "Recent studies have shown a decline in national breast cancer rates—there was a significant drop in 2003—but there is some suspicion that those numbers actually reflect a decrease in detection rates. Some doctors suspect that fewer women are getting mammograms."
Best Health Advice "Breast cancer risk is related to lifetime exposure to estrogen. The longer the exposure, the higher the risk. Early pregnancies have a protective effect. Also, lack of exercise, more than two drinks a day, and obesity contribute to breast cancer and are factors to monitor."
Allergy & Immunology
Colorado Allergy and Asthma Centers, Aurora South, Rose—Private practice for four years
Colorado Statistic Colorado's incidence of asthma is significantly above the national rate. In fact, only 16 states report higher levels than Colorado.
"I don't think that the incidence of asthma in Colorado is higher because of pollution or altitude; I believe it is higher because the primary-care and emergency room physicians in this state do an incredible job screening for asthma and collaborating with specialists to optimize management and control. Asthma can sometimes be a very subtle disease, and is therefore frequently difficult to diagnose, especially in the pediatric population. In states with a lower asthma prevalence, I would venture to guess there are thousands of patients floating around who have been misdiagnosed with "chronic cough" or "recurrent bronchitis" when what they really have is asthma. Another thing to take into consideration is that while Colorado's incidence of asthma may be higher than the national rate, we are ranked among the lowest in terms of morbidity and mortality associated with this disease. This is likely because Colorado is heavily laden with asthma specialists, whereas nationally there is a gigantic shortage of specialists to identify and treat this increasingly prevalent disease."
Think Again "A common misperception is that asthma is a condition that stems from being out of shape, which also infers that patients with asthma could alter their disease by getting into shape. This is absolutely untrue. Asthma is a genetically inherited, chronic inflammatory disease of the airways, which patients are genetically predisposed to, despite how good or bad their physical conditioning is."
Best Health Advice "People frequently ask if they can control or cure their asthma by staying away from pollution, exercising more, or doing breathing exercises. While all these things are helpful, they alone will fall short of controlling asthma. The cornerstone of proper management is daily inhalation with an anti-inflammatory medication. I tell my patients they must take their medication every day, no matter how good they are feeling, the same way a diabetic takes insulin every day."
Peak Pediatrics, Lutheran— Practicing for 17 years
Colorado Statistic Long known as the fittest state, Colorado could lose that distinction as our kids grow up. The activity level of Colorado's children ranks 35th among states.
"It's a generalization to say that our kids are inactive. In the real world, we see amazing couch potatoes and we see kids who are incredibly active. I don't have a good explanation why we rank in the lower half in the nation for activity, but I do believe that the activity level of children is, in general, directly related to the activity level of their parents. If the parents' idea of leisure time is going to the movies or watching television, they'll very likely end up with kids who think, and behave, the same way. Conversely, if parents golf, play tennis, run, ride bikes, they'll likely raise kids who think that being physically active is a good way to spend time. A lot of families mistake 'busy' for 'active;' if they have scout meetings and they belong to a lot of committees, they're going here and there—they're busy, busy, busy. They're always on the go, but not necessarily physically active. When I was young, kids were sent out to play and not allowed to come back inside until dinner. We ran through the garden hose, rode our bikes, ran around. But I rarely hear about that sort of unstructured activity any more. I hear parents say they don't like having the kids outside because they 'can't keep an eye on them.' I understand parents wanting to keep their kids safe, but when they don't insist on daily activity, they're increasing the risk of obesity, which is just as dangerous."
Food for Thought "I've absolutely seen an increase in childhood obesity in my practice. And I've seen an increase in other problems related to obesity—hypertension, kids on blood pressure medications—things I never saw in the first 10 years of my practice. Do you know that we now have charts that monitor body-mass index for kids? They go all the way down to age two."
Best Advice "Live the healthy kind of life you want your child to live. Don't intend to be more active, don't mean to eat better—actually do it. Parents have to live and model the healthy life they want their kids to live."
Pediatric Infectious Disease
Director of the department of pediatric infectious disease at the Children's Hospital; Professor of pediatrics at the University of Colorado School of Medicine—Practicing for 29 years, director for five years
Colorado Statistic Since 2000, Colorado has twice held the distinction of being ranked 50th in the nation for childhood immunization rates for primary immunization series.
"Each year, CDC (Centers for Disease Control) conducts an immunization survey of children aged 19 to 35 months to determine what percent of children in this age group have received all their recommended vaccines. The low immunization rate in Colorado in 2002-2003 was multi-factorial and was related to several different issues: a vaccine shortage for one particular vaccine, a lack of a 'medical home' for many children in Colorado, a lack of access to care, and lack of an immunization information system that would help medical providers know which vaccines a child had received if they changed providers. Colorado has made tremendous strides in improving immunization rates in children. In the spring of 2007, the CDC highlighted Colorado as one of two states in the country with the most significant increase in immunization rates in young children. Colorado had risen to one of the top 20 states in the county. The Colorado Immunization Information System allows medical providers to easily determine which vaccines a child has received and which vaccines are still needed. This has been very helpful to families and children, especially when they change providers, or move, or have a change in insurance that results in a need to change their medical home."
Food for Thought "A few years ago, the Institute of Medicine reviewed all the available information on vaccines and autism and concluded that there is strong evidence showing that vaccines do not cause autism in children. Having served on the FDA Advisory Committee on Vaccines, I can verify that vaccines are extensively tested for both safety and effectiveness before they are licensed for use in children."
Best Health Advice "Over half of vaccine-preventable diseases occur in children less than age two, so it's very important to be sure that our young children are up to date on immunizations."
Endocrinology, Diabetes, & Metabolism
Rose—Practicing for 25 years
Colorado Statistic The incidence of Type I diabetes is on the rise in Colorado. The increase from 1978 to 2004 was 2.3 percent per year.
"I've been thinking a lot about the statistic of diabetes on the rise, and I want to emphasize lifestyle. Diabetes is very important, and treating it is not about the latest drugs. Building relationships with patients and affecting changes in diet as well as exercise are more important to me than showering people with the latest drugs. Even though Type I diabetes has a genetic predisposition that requires insulin injections, lifestyle adjustments are necessary to control it. In order to find this treatment balance, some people require a major discussion about not going to the grocery store at midnight. It's a challenge to get the single guy who hits the bar to drink five beers to change his habit and go to the gym instead. When I see a patient, I take the history and I make the follow-up calls—without a computer in my office—so the patient knows I'm listening."
Scary Thought "I love practicing medicine, but I don't like that medicine has become a business. That's why doctors don't have time for their patients. Physicians are seen as a cost unit. Cutting costs means cutting time with patients."
Best Health Advice "I grew up in South Africa. When my mother needed groceries, I biked to the store and bought the essential basics. I got my exercise, and we ate basic foods. What people need now are exercise and basic food. Fruits and vegetables should predominate in the diet. Prepared foods should not be part of any diet plan."
Panorama Orthopedics & Spine Center, Littleton, St. Anthony Central, Lutheran—Practicing for five years
Colorado Statistic One of the most common injuries in skiing is the ACL tear. Some experts say that incidence of this injury has tripled over the last 20 years.
"The problem with the ACL tear is multi-factorial. No. 1, as the population grows, more people are doing more of these adventurous things. They're pushing limits, watching ESPN, and pretty much trying to be the next great thing. No. 2, a lot of that population is going the wrong direction in terms of being in shape. Better equipment lets you get to the next level, but it doesn't necessarily mean the body corresponds with it. Physical fitness is more important than age, but it's not so much being physically fit as it is having neuromuscular control over your body to not put yourself in a bad landing position. Most ACL injuries are noncontact injuries; it's not when you hit a tree or when someone runs you over. It's more a low-velocity injury, about planting and pivoting."
Scary Thought "For every mogul skier that comes in with an injury from the bumps at Mary Jane, there's a tow-line skier who came to a stop on a green slope and just caught an edge and twisted the knee. It doesn't have to be a high-energy activity to tear your ACL. And while most ACL injuries are relatively run-of-the-mill, if you happen to get a multi-ligament, or popliteal artery injury, now we go from doing an ACL surgery to what would surely be described as limb-salvage, to save the leg."
Who Knew? "ACL injuries are much more common with skiing than with snowboarding."
Best Health Advice "As long as we educate people on how to position their legs when they land, we can limit the number of injuries. It's all about body parts in space and anticipation. Be realistic about the activity you choose, and be in shape for that specific activity. Neuromuscular control [being conscious of your body-part placement and muscle coordination] has to be part of staying in shape."
Kaiser Permanente Highline Clinic, St. Joseph, Lutheran, Good Samaritan—Practicing for 25 years
Colorado Statistic According to Mental Health America of Colorado, the state has the seventh highest rate of suicide in the nation.
"No one really knows why our incidence is so high, although there is a lot of speculation. First of all, Western states have higher rates of suicide than Eastern states in general. In Colorado, one factor may be the great transience of our population. People moving in and out, never staying in one place, not living 'at home.' People in Colorado often are disconnected from their families. They have no long-term roots in a community. People often come here to get away or drop off the grid for a while. The wide-open spaces of the West provide a sort of anonymity you don't see elsewhere. And sometimes being faceless and anonymous could give a person already so inclined permission to commit suicide. People tell themselves that 'no one would miss me anyway,' or 'no one would even notice that I'm gone.'
The other issue contributing to the high rate of suicide here could be poor access to care. Access to mental health treatment is very limited in the rural communities on the Western Slope. In fact, a few weeks ago I spoke with the only psychiatrist in Gunnison County. The other issue with access is navigating the system. If you have a mole on your arm that needs attention, you know who to call. But people don't know what to do when they need mental health care. Even some general practitioners don't have a very good network for sending people to get help."
Steps in the Right Direction "This year, Colorado enacted better parity laws—laws that require insurance companies to cover certain mental health disorders just as they do physical ailments. Anorexia, post-traumatic stress disorder, anxiety disorder, depression, social phobia, and other disorders are included in these laws, which also require that co-pays to visit a therapist will be the same as a doctor visit. It's a good start."
Best Advice "No. 1, acknowledge your vulnerabilities and seek help when you need it; No. 2, maintain good boundaries, meaning know what problems to tackle and which ones to leave alone; No. 3, have a sense of humor; No. 4, try to find joy in everyday life; and No. 5, do not ever take a laptop or BlackBerry on vacation."
Colorado Permanente Medical Group P.C., Kaiser Franklin Medical Center, Good Samaritan, St. Joseph—Practicing for 21 years
Colorado Statistic While Colorado has the third-lowest rate of heart disease in the nation, it is still the leading cause of death in the state, killing more than 6,000 Coloradans annually.
"In Colorado, we are better than national levels when it comes to weight, and better than the national averages when it comes to smoking. That is probably why our cardiovascular disease rate is lower. That probably explains it, but it isn't a reason to celebrate. We still have too many people who are overweight, who don't exercise enough—four days a week is a minimum—who don't eat a heart-healthy diet, and about 20 percent to 30 percent of people smoke. The heart is such a central organ. It's the sign of life. Fortunately, people will often have some warning symptoms. One of the things that's amazing about heart disease is that it's a real life-changing event and people are in a position to really look at their lifestyle. It's often a family thing, where if they have involvement and support from the family they generally do much better. Trying to resume a normal life after you've had a heart problem is challenging, and lifestyle can help you to feel healthier and to have an image of a healthy person."
Scary Thought "I am concerned with the increased rates in younger people. We're seeing some awfully young people with heart attacks, and most of those risks and problems come from lifestyle."
Best Health Advice "Making exercise part of your life is one of the most important things you can do. First of all, everything counts. Look for any way that you can fit it in your life. Park a little farther away from the door. Take the stairs. Get at least 30 minutes of exercise at least four times a week that causes you to huff and puff and break a sweat."
Pediatrix Medical Group, Medical Director of intensive care nursery at Sky Ridge, Littleton, North Suburban, Rose, Swedish—Practicing for 23 years
Colorado Statistic Colorado's incidence of low birth-weight babies is 1.5 percent higher than the national average, ranking the state at 40th.
"As a neonatologist, I see low birth-weight babies every day. But Colorado's rate is unusually high—and it has been for some time. There are probably four factors that contribute most to low birth weight. One, multiple births, which account for about one in every five births here in Colorado. Two, smoking. If we could eliminate smoking among pregnant women, we could lower the low birth-weight rate by 11.9 percent. Three, premature rupture of the membranes, which is a bit more elusive but can often be prevented with good prenatal care. And four, inadequate maternal weight gain during pregnancy. Inadequate weight gain is the largest contributor to low birth-weight rates among single-birth babies. I think women are often too focused on not gaining too much when they should be focused on gaining enough. With that said, there are plenty of reasons why babies are born with low birth weight that have nothing to do with what the mom or the physician did. Sometimes it just happens."
Reality Check "High altitude contributes to an excess of low birth weight, and this excess increases as altitude increases. At high altitude (more than 9,000 feet) there is a 50 percent excess compared to 3,000 to 5,000 feet. For every 1,000 feet of increased altitude between 3,000 and 11,000 feet, there is a decrease of one ounce in birth weight."
Best Health Advice "There isn't a magic number for how much weight a woman should gain during pregnancy. Ask your doctor what would be right for you and focus on that."