For the liver cancer specialist, a day involves a lot more than scalpel work.
6 a.m. I wake for an early tumor-board meeting, so my teenage son needs to be up, too. We have less than an hour to get him to school by 6:45 a.m. and me to the meeting by 7:15 a.m. I bribe him with pizza for dinner.
7:15 a.m. Tumor board this week focuses on patients with metastatic neuroendocrine cancers. There’s a new FDA-approved peptide-based receptor radionuclide therapy (PRRT) for that group of diseases. Most of the discussion this morning revolves around what this will mean for them and us in coming months.
8:30 a.m. I meet a patient in the pre-op area to discuss the liver surgery he’s about to undergo as part of his cancer treatment. After answering a few questions and escorting him to the operating room, I have 45 minutes to call the referring physicians and update them on the next steps.
9:30 a.m. Today’s surgery is a liver resection for a large primary liver cancer. Because of the size and location of the tumor, and the fact that the liver function was well preserved, we all agreed that surgical removal of the cancer was the best option for him. We spend 3.5 hours teasing a football-sized tumor out of the intricate network of bridging structures within the liver.
1 p.m. As we’re wrapping up, I take a picture of the tumor for the patient and send the specimen to pathology. I have an hour before clinic starts, so I wash up, then check on a few patients.
2 p.m. At today’s clinic, we see five patients being considered for liver transplants. As director of the liver cancer program at IU Health, my role is to explain the transplant evaluation process.
4:30 p.m. After clinic, I head back to my office. My assistant has left a pile of papers on my chair: paperwork to sign, patient images to review, and phone calls to return. My thermos of coffee is still sitting on my desk from this morning, and I consume that with some peanut butter and crackers over the next 90 minutes as I handle the administrative work.
6 p.m. I still have a handful of things on my to-do list, but if I leave now, I can meet my husband for a workout at Orangetheory Fitness near our home. So I do.
9 p.m. After a workout, I log on to complete my notes from clinic and record my operative note from the case this morning.
10:30 p.m. Unable to focus any longer, I watch a couple of Death in Paradise episodes on Netflix until I fall asleep.
FAITH AND HEALING
Franciscan pediatrician Mary Elise Hodson uses cutting-edge medicine to treat the sick children in her care. But she thinks having a little faith helps, too—not in changing the treatment’s ultimate outcome, but in helping families cope with adversity and pain.
There’s this debate about whether faith improves medical outcomes. I think it has a big impact for a lot of people. It may not result in physical healing, but it absolutely changes their perspective on their health and treatment. I’ve seen that happen. Years ago, I had a patient who had a horrible accident and a severe head injury, who did not survive. But her parents’ faith carried them through that horrible time. It doesn’t make the grief go away, but it helps people handle it differently.
What people pray for varies a lot. Sure, some people pray for healing, because ultimately that’s what we all want. But I also think they know that sometimes the answer is no—that the medical condition isn’t going to improve. So they pray for strength. They pray for the ability to understand what they’re going through. They pray for the ability to help support their child emotionally to help them to get through what they’re going through. Some people also pray that they can just be a shining light for somebody else. I’ve read some of my patients’ Facebook posts. They talk about how they were able to share their faith with a new nurse who had never taken care of them before, and how it was such an amazing thing and a great opportunity.
But often, there’s more to handling the emotional experience of disease than prayer. It helps to have people around you who you can talk to and rely on. People who will drop off meals for your family. People who will run to the store for you when you’re coming home from the hospital tomorrow and there’s nothing to eat in the house. A support system you can call on and say, “I need you,” and they’re there. That’s incredibly important any time you’re dealing with a chronic illness or a life-threatening situation.
Sometimes this sort of support comes from faith-based groups, and sometimes it comes from those who are just really good friends or family members. Usually, it’s a combination of the two. Having that makes all the difference in the world.
CHEMOTHERAPY FOR BREAST CANCER
Breast cancer treatment has long been a hot-button issue for women. Thirty years ago, patients challenged the overuse of radical mastectomies. Today, some decry what they see as an overuse of chemotherapy, which in many cases has little effect on breast cancer. We asked St. Vincent breast-care services medical director Dr. Erica Giblin for her take on the controversy.
I totally understand women’s concern over this issue. But the facts are more nuanced than simply saying that chemotherapy isn’t effective against breast cancer. I think that, in general, the public sees this disease as a single entity. Well, we now know that breast cancer is at least 15 to 20 different kinds of cancer, each with a different MO. So comparing one woman’s breast cancer to another’s is almost like comparing apples to oranges. One of the most important variables is how these different cancer types respond to chemotherapy. Some, indeed, don’t respond very much. But for other forms, chemo can be effective. The trick is knowing which is which.
Traditionally, the way we approached breast cancer was based on the size of the tumor and whether or not the nearby lymph nodes were affected. Now it’s more targeted and specific in terms of identifying which breast cancer it is, and if it responds to chemotherapy. We’re also working to determine which breast cancers have a higher risk of recurring, because those are the types where we want to use chemo. But we don’t want to shoot from the hip and give it to everybody, based solely on the size of the tumor. Cancer is more sophisticated. It’s smarter than that. So we have to outsmart it.
New diagnostic tools are coming online constantly. We’re looking into the DNA of cancers to determine which have high recurrence risks. The types of tests we’re using are very innovative, and I think that’s where the future of cancer care is going—and not just for breast cancer. I think this sort of precision medicine is the future for all forms of the disease.
We now have the testing capabilities to offer personalized medical care for specific women, and to determine who will benefit from chemotherapy and who won’t. The goal is that particular, specific measures can be used to treat a woman’s individual breast cancer. I tell my patients it’s like Goldilocks and the Three Bears. We don’t want to overtreat you, we don’t want to undertreat you. We want to give you the treatment that’s just right for you. And now, thanks to the diagnostic tools in use today, we have that capacity.
Dr. James Perry, OB/Gyn at Community Health Network
One of the joys of this MD’s day is collaborating with his wife.
6 a.m. As soon as I wake, I log on to my laptop and check the hospital census to see who’s currently admitted. I’ll be covering not only my own patients today, but some of my partners’.
7:30 a.m. At the hospital, I confer with one of my partners who was on call the previous night. The most pressing case is a woman in early labor with a pregnancy complicated by gestational diabetes. The second most pressing issue is a patient who is 15 weeks pregnant with a severe headache and fever. We’re trying to rule out meningitis, so we order a spinal tap.
8 a.m. I examine my laboring patient and break her water. She’s currently dilated to 3 centimeters.
8:10 a.m. Heading to another ward, I check on my 15-week patient with the headache. She’s obviously not feeling well, but I don’t think her symptoms are severe enough for meningitis. We await the results of the spinal tap later this morning.
8:30 a.m. I start to see patients in my office, which is within walking distance of the hospital. The first young woman is 36-weeks pregnant with her first child, and she’s excited. For me, this is also a moment of joy, having known her since she was a little girl who played soccer with my daughter.
9:15 a.m. I see another young woman who is at 36 weeks. She had been physically abused by her boyfriend earlier in the pregnancy, which required hospitalization. Luckily, the baby has not shown signs of injury, but we’re watching her closely with ultrasounds and monitoring.
10:30 a.m. After seeing a few more patients in the office, I walk back to the hospital and check on the woman in labor. The fetal heart rate is reassuring, and she’s at 5–6 centimeters dilated now.
11 a.m. My wife—who is also a physician and my professional partner—asks me to take a quick look at one of her patients, who has an unusual lesion on her vulva. It doesn’t look cancerous, but neither one of us is quite sure what it is. After digging out a textbook, we come to the conclusion that it’s lichen planus, a form of dermatitis, and prescribe the appropriate ointment.
11:55 a.m. My labor patient is nearing delivery, so I change into scrubs. As the patient begins to push, the fetal heart rate drops from 130 to 60—low enough for me to perform an assisted delivery. I quickly obtain consent and proceed with a vacuum extraction. The baby has two loops of umbilical cord around its neck. After I loosen the cord loops, the baby quickly recovers. I congratulate the new parents.
1 p.m. I grab a quick cup of coffee on my way back to the office. My first patient has some benign bleeding issues and has tried multiple treatments, including hormonal therapy. We decide on a hysterectomy.
2:30 p.m. My wife calls me once again to examine a new patient with a worrisome lesion on her cervix. It appears to be cervix cancer, most likely Stage 2 or greater. We counsel the patient and schedule her for a biopsy.
3:15 p.m. I check on my 15-week-pregnant patient with the headache and fever. The lumbar puncture didn’t show meningitis, but the chest X-ray did show pneumonia. We agree she should stay in the hospital for another day or two for antibiotics.
4 p.m. My last patient’s breast tumor was found and treated two years ago, but she recently was diagnosed with a bone metastasis. Both she and her oncologist are requesting removal of her ovaries, a surgery we schedule for the following week.
4:45 p.m. It’s Friday, so I call my partner who has on-call duty this weekend to discuss the plan for my patient with pneumonia as well as several postpartum patients still in the hospital.
5 p.m. My wife calls and tells me to meet her at Vino Villa for dinner. My children, having finished at an internship and football practice, are on their way.
The anti-vaxxing movement, though scientifically debunked, still holds sway with a swath of the public. Dr. Sarah Stelzner, pediatrician at Eskenazi Medical Group, says the key to solving this issue isn’t throwing more facts at reluctant patients, but building trust.
For doctors, the number of anti-vaxxing stories you hear varies by location, and by the population you serve. I work at Eskenazi, and most of my patients are eager to get vaccinated. Many come from other countries, and they’ve seen what happens if you don’t. Witnessing these diseases in action really changes one’s outlook.
In a similar vein, a couple of years ago, the American Academy of Pediatrics asked older physicians who had been around before the influenza vaccine, and who went through the polio scare and actually saw measles, to help educate younger pediatricians. Because of vaccines, many of them—just like their patients—have never seen firsthand the damage these ailments can do to the unprotected.
The main resistance we have within our own practice is to the flu vaccine and the one for human papillomavirus. I’ve had multiple mothers tell me that they’re not vaccinating for HPV. They don’t want to face anything that has to do with STDs. They don’t want to address the high likelihood that their children eventually are going to be sexually active. It’s a really difficult topic to address.
The Indiana Immunization Coalition has developed an interesting approach to this issue. If families say, “I’ll make sure my kids are not doing that,” then you need to mention, especially to mothers of girls, the high incidence of sexual assault. It’s hard to say that, but sex may not be their choice, and don’t you want your daughter to be protected in case? And how do you know that her eventual partner in life hasn’t himself been exposed? So there’s a couple of good reasons why you want to protect everybody.
I think it’s better just to promote the reasons for vaccinations than argue with people who don’t want to get vaccinated. I think that unless you’re fully onboard, it’s frightening to have something injected into your child on a regular basis. Especially when you might have people you care about and respect telling you that you shouldn’t do that, or that it’s dangerous.
For pediatricians, this is definitely a medical issue. We know the tragedy that can result from cervical cancer. Also, while we don’t see some other infections often, we do see things like chicken pox, and there are measles outbreaks on college campuses pretty much every year. I’ve seen rubella in the last five years, and whooping cough is still an issue.
I think the best way to tackle this is for people to have a trusting relationship with their primary care doctor. That’s really what’s going to help them feel comfortable with the recommendations we give.
Dr. William Berg, Interventional Cardiologist at Franciscan Health
The heart specialist spends days like this delivering good news and bad.
6:30 a.m. Immediately upon arriving at the hospital, I meet with my colleague who worked the night shift to get an update on any patients who came in overnight. I like to come in early to check my inbox and read through medical records of patients I’ll see today.
7:25 a.m. A patient came into the ER yesterday afternoon after collapsing from a heart attack and sustaining a serious head injury from the fall. Unfortunately, the brain bleed worsened and the patient died this morning. Another colleague and I give the sad news to the family.
7:45 a.m. I talk to our discharge nurses about a couple of patients I am sending home, emphasizing what needs to be done before and after that happens.
8:10 a.m. In the lab, I put on my lead apron to do the first cardiac catheterization procedure of the day. The imaging shows a serious narrowing of the patient’s artery. I consult with a vascular surgeon and advise the patient that a bypass surgery will be needed to increase blood flow.
8:55 a.m. I go to see another patient to talk about a transfer to an extended-care facility for rehabilitation. When delivering difficult news, I prefer to sit in a chair next to my patient’s bed so we can be more at eye level when we talk.
9:25 a.m. I go into my next cath procedure with a patient who had an abnormal stress test. The patient’s spouse had passed away recently, which can be such a stressful time for a family. Fortunately, the results came out clean, and I was able to give good news.
10:05 a.m. I meet with a device company representative about equipment I use in the lab. So much of what we do is technology-based that it’s good to stay on top of what’s out there.
10:24 a.m. Another cardiac cath, another patient with several blocked arteries. The patient will need a coronary artery bypass surgery, so I call the cardiac surgeon’s office for a consultation.
11:30 a.m. I sit down for a minute while an ER patient is moved to the cath lab, and I do some charting as I pull up highlights on my phone from the Packers football game last evening that I wasn’t able to watch.
11:40 a.m. I go in for a cath on the ER patient, and luckily, no intervention is needed. I deliver the good news to the family.
1 p.m. After grabbing a quick bite to eat in the cafeteria, I start a cath on a patient with low blood supply to his foot. His artery is totally blocked. It’s a challenging case that consumes almost two hours, but with the help of another colleague, I’m able to get the artery open to re-establish blood flow.
3:10 p.m. I make a phone call to an insurance company to get prior approval for a procedure. It goes better than these usually do.
3:30 p.m. I sit down for a minute to clean out my inbox and review test results. Then I create a list of my patients, their problems, and their care plans for my colleagues covering the upcoming weekend.
4:30 p.m. I meet with the physician assistants to follow up on my patients who had procedures today. There are multiple late admissions to the ER and other hospitals with cardiac diagnoses on the board, so I’m checking to see where I can help my colleagues.
4:50 p.m. I get a page from the ER about a patient coming in with chest pain and ST-elevation on their EKG (having a heart attack), so the patient goes directly to the lab for an emergency heart cath. I’m able to open the LAD artery (“the widow maker”) and re-establish blood flow. I talk with the anxious family and let them know the procedure worked.
6:15 p.m. I leave the hospital for the day. Given that it’s Friday, I’m especially happy there are no after-work meetings.
Cannabis has been in the news a lot lately, but it’s not making its way into many Hoosier treatment programs yet—or at least not in a form the average stoner would recognize. Though the jury’s still out on the benefits of weed, Dr. Andrew Greenspan, hematologist/oncologist at IU Health, sees lots of public interest, and the possibility of benefits.
Probably 30 percent of my patients ask about the potential benefits of medical marijuana. I tell them that right now I can’t give them an answer as to whether it’s safe or effective against their cancer. It’s not FDA- or DEA-recognized. In fact, the cannabis plant is still a Schedule 1 drug. But we do have the compound CBD. It comes from hemp oil, and it’s the non-psychoactive element that’s found in cannabis—one of the two major elements the plant contains. The other is THC, which is the psychoactive component. CBD may be effective in seizure disorders. It may also be effective in limiting brain damage from acute trauma or concussions.
Those things are currently being studied.
There are other possible uses. The human body’s endocannabinoid system includes two protein receptors, CB1 and CB2, and both THC and CBD can stimulate those receptors and might have some effect on the organ systems where the receptors are located. They’re found not only in the brain, but also in the skin, bones, digestive tract, and even the liver. So the potential uses of medicinal marijuana are not only for pain or brain issues, but for other diseases, from irritable bowel syndrome to appetite loss.
Two products incorporating synthetic versions of marijuana’s active ingredients have been on the market for some time. One of them is for the appetite loss that cancer patients experience, as well as nausea. And there’s a second product for multiple sclerosis that’s a combination of both THC and CBD.
There are a lot of opportunities for further research. We have to study whether the compounds are safe, then try to understand which delivery systems—be it via aerosol, combustion, ingestion, or topical application—work best. Once we know those things, we need to find out whether it interferes positively or negatively with traditional drugs, and whether it might replace them. It’s a long process, but I think it’s certainly something that, in the correct clinical research environment, could be quite promising.
Dr. Juanita Albright, Internal Medicine Physician at St. Vincent
Even after this internist goes home, the work persists.
6:45 a.m. My twin boys are out the door to meet the bus, and my oldest son and I soon follow.
7:30 a.m. I arrive at the office in time to review a few lab reports and check messages before my first patient.
7:45 a.m. The morning starts with follow-up visits for hypertension, diabetes, and hyperlipidemia. I review labs with patients, answer their questions, and make sure their medication lists are up to date.
9:05 a.m. Several physicals follow. I see some of my patients only once yearly, so I enjoy catching up with them and learning what’s going on in their lives.
10 a.m. A patient comes in for a procedure to have a cyst removed from her back. It goes smoothly, and she’s out the door with instructions to return for suture removal.
10:30 a.m. I continue to see patients while trying to keep up with the ever-lengthening list of messages that need to be answered today.
11:15 a.m. I take a quick minute to respond to a text regarding my availability to pilot a three-wheeled bike next week for Cycling Without Age, a nonprofit organization I’m involved with that provides bicycle rides for the elderly and people unable to cycle independently. Awesome group, and I love seeing older people getting outdoors and being mobile.
12:30 p.m. I finish my morning only a half-hour behind, which is typical for a busy morning. I spend 10 minutes eating lunch while listening to a pharmaceutical rep fill me in on a change in the administering information regarding an insulin drug.
12:45 p.m. I have 15 minutes to review more messages and answer some emails before my afternoon patients start to arrive.
1 p.m. I begin the afternoon with a physical. I do a lot of them.
1:30 p.m. Between patients, I look into some of their questions on UpToDate, a research-based site for healthcare professionals.
1:45 p.m. A pharmacy isn’t receiving the electronic prescriptions from our office, so I send an email in hopes of getting the problem resolved.
2 p.m. I see a new patient with carpal tunnel syndrome and back pain. I send a message to the nurse to get prior imaging reports and set up follow-up appointment, so we can discuss the results.
2:35 p.m. I close out the afternoon seeing a hypertension patient and doing several more physicals.
4:20 p.m. I head home to see my twins, who arrived there from school at 3:30 p.m. We review what homework they have. Between working on messages and reviewing labs, I begin making dinner and throw a load of laundry into the washing machine.
6 p.m. After picking up my son from marching band practice, I stop at the rehab/long-term care facility where I often see patients. I visit a patient in assisted living, who has been dealing with a cough recently. I make sure her lungs are clear. Geriatrics is one of my passions, and seeing patients here makes me happy.
6:40 p.m. I head down the hall to attend the 70th anniversary celebration of two of my patients. I enjoy seeing younger pictures of them, and it’s a good time to connect with their family.
7 p.m. My son is ready to go home. When we arrive there, I finish up dinner and spend a little time talking with my family around the table.
8 p.m. I help my boys with their bedtime routines. As I come down the stairs, I’m greeted with a mound of clean laundry on the living room floor that requires folding. But I have more work messages to respond to, labs to review, and prescriptions to authorize. It will be a couple of hours before I can call it a day.
Some doctors work very long days. Just ask Franciscan Health’s William Berg, one of the MDs who kept a record of a typical shift for us. As Dr. Berg and his colleagues will tell you, serving the public makes the extended hours worthwhile. That’s the way we feel about publishing this list of the best local physicians in the business. Indianapolis Monthly’s annual Top Doctors guide takes months to produce, but in the end, it makes finding a great specialist easy. The whole thing starts with a question that’s about as reliable a measure of quality as it gets: Which doctors do physicians turn to for their own care?
Castle Connolly Medical Ltd., a healthcare research and information company, compiled this year’s honorees by asking physicians to recommend someone they would see themselves or suggest to a family member in Central Indiana. More than 900 licensed medical professionals in the area, representing dozens of specialties, met Castle Connolly’s qualifications. This year’s list for IM considered physicians in Marion, Hamilton, Madison, Boone, Johnson, Hendricks, Hancock, Morgan, and Shelby counties.
Castle Connolly was founded in 1991 by a former medical college board chair and president to help identify America’s top doctors and hospitals. Its established nomination survey, research, screening, and selection process, under the direction of an MD, involves hundreds of thousands of physicians as well as academic medical centers, specialty hospitals, and regional and community hospitals across the nation. The nomination process is open to all licensed physicians in America. Those doctors are able to nominate physicians in any medical specialty (except fields in which patients rarely have a choice, such as emergency medicine or anesthesiology) and in any part of the country, as well as indicate whether the nominated physicians are, in their opinion, among the best in their region or the nation in their medical specialty. Castle Connolly then carefully screens doctors’ educational and professional experience before making its final selections. Doctors do not and cannot pay to be considered for Castle Connolly’s Top Doctors designation. The result: Castle Connolly identifies the top doctors in America and provides detailed information about their education, training, and special expertise in its paperback guides, online directories, and “Top Doctors” features in national and regional magazines.
The selected physicians may also appear online or in conjunction with other Castle Connolly Top Doctors databases online and/or in print. The nomination process can be found at castleconnolly.com/nominations.