Arkansas is the perfect place to try out this new health trend. Read all about the what, why, where and how here.
Rheumatologist Eleanor Lipsmeyer owns the Arkansas Times' Best Doctor lists. She made the cover of the first issue in 1995 and has been nominated by her peers to the list ever since. More perennials: ophthalmologist Carol Chappell, cancer surgeons Kent Westbrook and Suzanne Klimberg, oncologist Laura Hutchins. Ditto neurologist Lee Archer. Physicians with a lot of experience, the big names. Mentors to most of Arkansas's doctors.
So this year, the Times decided to dissect the winners list to find some young and previously unheralded doctors. The doctors profiled here range in age from 34 to 41, and many consider themselves to be at the beginning of their careers.
These aren't the only young doctors to be nominated by their peers to the Best Doctors® and the Times lists. We worked with certain criteria — number of times a name was mentioned and our ability to determine a nominee's age — and so this should be considered merely a sample of what young physicians are bringing to Little Rock. With youth comes advanced techniques learned in recently completed fellowships and many hours spent in clinics and operating rooms. The diverse group, including Arkansans, a Chilean, the son of Taiwanese immigrants, a Ghanan, a Brazilian — even someone from Des Moines — have brought new blood and new ideas to Arkansas medicine.
Jason Badgwell, 38
Pancreatic cancer, melanoma
Jason Badgwell came to the University of Arkansas for Medical Sciences after completing a fellowship at M.D. Anderson in Houston three and a half years ago. He is a general cancer surgeon who concentrates on pancreatic cancer and melanoma, and does some colorectal surgery and "a lot of weird stuff," rare cases referred to UAMS. (For example: Cancer of the appendix is a 1-in-a-million occurrence; he's seeing four cases a year.) Badgwell operates on cancers for which there is no good chemotherapy and are radiation resistant, cases in which surgery is the only curative treatment.
Yet, 80 percent of patients who present with pancreatic cancer can not be operated on. The disease doesn't create symptoms until it causes an obstruction and pain. And after surgery, survival to five years is rare; only 15 percent of those operated on will get a cure. So that's 15 percent of 20 percent.
With such dim prospects, what makes Badgwell love surgery? "It's the most challenging. That's what drew me to it. It's the hardest surgery you can do, and there's a lot of room for improvement." And the patients he sees "I can potentially cure." The ability to treat patients with advanced cases of cancer makes him feel, he said, "like I'm filling a need in the state of Arkansas."
Some of Badgwell's surgery is palliative — done to ease pain rather than seek a cure. He also has a first at UAMS: An "isolated limb perfusion," a treatment for melanoma that has spread along the lymphatic system to the arms or legs. The blood circulation from the limb is blocked with a tourniquet so that the doctor can inject an artery or vessel with a high dose of chemo that won't spread to the rest of the body. It's a procedure he learned at M.D. Anderson.
Lanessa Bass, 35
Lanessa Bass likes to teach and see patients, something she can do at Arkansas Children's Hospital, and she likes living in the big city — which Little Rock can feel like to someone who was raised in Hawkins in East Texas.
After getting her MD at the University of Galveston, the oldest medical school west of the Mississippi she tells us, Bass did her residency training at Children's. After a brief detour back to Texas, Bass returned to ACH in 2007 to join the faculty. (She's also working on a master's degree in education from the University of Cincinnati.)
Bass likes inpatient medicine, "working through the complexity of a patient that is admitted ... to find out what the diagnosis is with as limited testing as you can do." Outpatient, she enjoys preventative medicine, working with parents on developmental issues with their babies, preparing them for the next stage, giving them the "long-term view." She wants parents to enjoy each stage, to favor teaching over punishment and to act as role models. Parents and grandparents need to realize "how much kids are watching, from conversation to how we handle frustration," she said, because those are the behaviors children will mimic.
"What I've always been attracted to in our hospital is we have such a great mix: a large children's hospital with all the services, services for the whole state. It's very unique," Bass said.
One of those services is ACH's obesity clinic. Bass says it's the pediatrician's responsibility to address the issue of obesity. "I have brought it up with infant feeding habits and toddler feeding habits. ... We can do it in a way that is respectful and mindful." Addressing the overfeeding of an infant or toddler is as important as attending to a child that isn't growing, she said.
Bass laughed when she recalled that in training she was told by patients "you're too young." "I don't hear that as much now," she said.
Jasen Chi, 41
Jasen Chi, a rheumatologist in practice for six years with OrthoArkansas, came to Little Rock from Taiwan as a teen-ager with his family, the owners of Chi's Chinese, the Sushi Cafe and Sekisui. He learned to speak English, was accepted at Vanderbilt, where he majored in biochemistry, and earned his medical degree from the University of Arkansas for Medical Sciences. He did an internship and residency at the University of Memphis and returned home to do a fellowship in rheumatology. "My surgeon friends say it's gratifying when they can take a tumor out, or fix a fracture." His reward: "When someone is confined to a wheelchair, it's a blessing to be able to help that person get up and walk and have a normal quality of life." The bulk of his caseload is rheumatoid arthritis, a debilitating disease caused by an overactive immune system. "The new focus now is to treat the disease process as early as possible and be aggressive," he said, to treat during that window of opportunity before joints begin irreversible erosion and organs are damaged. The goal, Chi said, is "when you look at a patient with rheumatoid arthritis, to not be able to tell they have it."
Chi, who is on the board of the Arthritis Foundation, and OrthoArkansas are involved in seven studies looking at new drugs for arthritis and lupus and at cardiovascular risk factors with new drugs used to treat gout and RA. Rheumatoid arthritis is now treated with injected and infused drugs, chemicals that work to slow down the immune system's "assembly line" that has been turning out too many antibodies.
Chi was, but is no longer, the youngest doctor at OrthoArkansas. Younger still is hand surgeon Richard Wirges, 36 — another doctor who got the nod from his colleagues as one of Arkansas's best doctors and who is profiled below.
Jerri Fant, 41
In practice for 10 years, Jerri Fant isn't exactly in the infancy of her practice. But she is in the infancy of motherhood, with her 4-month-old son, Griffen, so her life mimics that of a younger person. "If you have a career, you can't do things younger," she said about her late motherhood. And though she wouldn't necessarily call herself a young doctor, she said, "I'll take it."
Fant has been an independent practitioner for seven years, with offices in Little Rock and North Little Rock. She moved from a large group practice to her own shop because "I like the idea of having autonomy in how I handle patient care," she explained; in a group practice she might have to see far more than the 90 to 100 patients she sees in her two (long) days of clinic.
"I spend a lot of time communicating with patients. ... I like to have the freedom to make sure they [her patients] understand what they have and the options for curing it."
A Little Rock native, Fant is a graduate of Duke University in North Carolina and got her medical degree from the University of Arkansas for Medical Sciences. She did a residency in general surgery at UAMS and breast surgery at Baylor Medical Center in Dallas. She had a particular interest in breast cancer — both her grandmothers had it. "I also love surgery," she said; tying the two together made sense. She does not own her own surgery clinic, but operates at St. Vincent Health, Baptist Health and other surgery centers.
Fant sees her patients every six months for five years after surgery and annually after that. She likes that continuity of care, which allows her to have a relationship with patients that is similar to the family practice doctor's. Fant also enjoys the "camaraderie" of the multidisciplinary approach that treating breast cancer requires, working with radiologists, medical oncologists and pathologists.
The biggest advances being made in treating breast cancer today, Fant said, are in DNA research into the biology of breast cancers. Knowing how certain breast cancers act — which are aggressive, which aren't — helps oncologists decide the best course of therapy for the patient.
Matthew Katz, 39
Prostate cancer, kidney stones
Matthew Katz is the rare doctor who moved from private practice to a teaching hospital. The cancer surgeon has been in practice for three years, the last year at the University of Arkansas for Medical Sciences, because "I wanted to do academics." Yes, he took a pay cut. But, thanks to a two-year subspecialty fellowship training in laparoscopy and robotic surgery at Washington University unique among doctors in Arkansas, Katz was gratified to be able to bring new surgical technique to UAMS. With Dr. Stephen Canon, ACH chief of pediatric urology who Katz trained on the Da Vinci robot, he performed the first robotic pediatric urology surgery at ACH, a partial kidney removal. "I learned from some of the best surgeons in the country," Katz said; now he is teaching advanced techniques "to the future urologists of Arkansas."
"I enjoy treating cancer patients," Katz said. "It makes sense to me: someone has cancer and I remove it," with a cure as the goal. "And on top of that I really enjoy laparascopic and robotic and I knew it was the wave of the future."
The U.S. Preventative Services Task Force released a statement last week that a review of the science shows asymptomatic men are not benefiting from PSA (prostate-specific antigen) blood tests, which screen for prostate cancer, and recommended against the test. The controversial report said the test could cause more harm than good, since some forms of prostate cancer are relatively benign. "We overtreat prostate cancer by 50 percent," Katz said, subjecting patients with non-aggressive forms to radiation and surgery that can cause impotence and other problems. One in six men will get prostate cancer; age is the risk factor. There are no symptoms of early stage cancer, which is why the PSA blood screen is used.
Katz says younger men should still be screened. But, "Does a 75-year-old man need to have a PSA test? I'd say not."
Katz is involved in research to identify serum proteins that are markers for more aggressive forms of prostate cancer. "If we can find that, we can spare men who don't need the treatment."
Katz is also involved in a study that fuses PET (positron emission tomography) and CAT (computerized axial tomography) scans to image prostate cancer cells within the prostate or lymph nodes.
Jonathan Laryea, 41
At 41, Jonathan Laryea is pushing the "young doctor" description a bit. But he's followed a circuitous path to the University of Arkansas for Medical Sciences, one that started in Ghana, took him to Johns Hopkins, Yale University's Waterbury Hospital and the Georgia Colon and Rectal Surgery Clinic in Atlanta. Along the way, he changed his focus from neurosurgery, which he'd gone into because of his admiration for a neurosurgeon at Johns Hopkins, to cardiothoracic surgery to colorectal surgery, which he discovered during rotation to be the specialty he loved. He was recruited to UAMS from Atlanta five years ago. "I didn't know jack about Arkansas," he said, except that it was where Bill Clinton was from.
Talking about matters of the colon and rectum — in a serious sense, at least — doesn't come easy to people. That shyness, plus fear of a bad diagnosis, means people may drag their feet when it comes to bringing symptoms to the attention of a doctor.
But the majority of people will not have symptoms, so colonoscopies are crucial to catch cancer early; people diagnosed with stage one rectal cancer have "upwards of 90 percent survival," Laryea said. Because of the increased use of colonoscopies, colon cancer is on the decline — but it's still the third leading cause of cancer death in men and women. "For this year alone, the expected incidence is 140,000 new cases in the United States. Fifty-thousand are expected to die," Laryea said. People with no family history should start scheduling colonoscopies at age 50, earlier if they do. Those with genetic disorders that make them prone to colorectal diseases should start in their 20s.
Laryea also does surgeries for colitis, Crohn's Disease, diverticulitis, fecal incontinence and sphincter repairs. He does both laparoscopic and robotic surgery for colon and rectal cancer. (The robot allows the surgeon to manipulate instruments with precision and stability. UAMS only has one. The surgeons would like have another, if anyone reading this has $3 million to spare.)
So, the inevitable question: Why does a doctor go into colorectal surgery, choose this almost taboo part of the body to focus on? Laryea laughs, and repeats what he read on a listserv for colorectal surgeons: "Some say, 'I was at the bottom of my class.' "
Erick Messias, 40
Erick Messias, a psychiatrist and epidemiologist at the University of Arkansas for Medical Sciences, has a warning for parents of depressed children: There's a correlation between depression and the Internet and video games.
Which came first? The Centers for Disease Control's 2007 and 2009 Youth Risk Behavior Survey he examined doesn't hold the answer. But what Messias, who came to UAMS' two years ago to head the Walker Family Clinic at the Psychiatric Research Institute, was able to determine was that there is a correlation between excessive Internet and gaming and depression. Teens who spend more than five hours a day — some 10 percent of the CDC's data sample of thousands of teens — had a significantly greater risk for sadness, suicide ideation, suicide plans, attempted suicide and treatments for attempts.
The CDC data also found that 8.4 percent of the teen-agers it surveyed in its annual assessment are spending five hours (highly associated with reports of sadness) or more on the Internet or gaming on school days.
Children who are socially isolated because of their depression use the Internet; those who overuse the Internet are isolating themselves. "Parents need to be aware" of how much time their children are spending online and what types of games they're playing, he said. Messias presented the results of the research at an international meeting last May.
"The idea that we live an online lifestyle is here. We need to learn what the impact is on our lives," Messias said.
Messias got his medical degree in his native Brazil, did a residency at the University of Maryland, got a master's degree in public health, a PhD in epidemiology and did a second residency in preventive medicine at Johns Hopkins. He bemoans the fact that psychiatry has moved away from talk therapy and into drug management. He allows 30 minutes for med checks with his patients, twice as long as the usual appointment. "I was lucky enough to train when psychiatrists learned to do therapy," he said. "I think [psychiatry] is losing its soul."
"We have started to define ourselves as brain and we have lost our mind ... I think we are at least a mind and probably a soul, though there's no proof of that scientifically." To press the issue, however, "would completely isolate me as a psychiatrist," Messias said.
There is a non-talk and non-drug therapy Messias would like to institute at UAMS: Transcranial Magnetic Stimulation, for depression that doesn't respond to drugs. "That's my goal now. My letter to Santa," he said. UAMS has a TMS machine that it uses in its tinnitus (ringing in the ears) research, but it's not the machine the FDA has approved for use with depressed patients. "I think it's a good alternative and that people from Arkansas should have access to it," Messias said.
Maurecio Moreno, 38
Reconstructive head and neck surgery, head and neck cancer
Here's what Mauricio Moreno can do: He can take part of your fibula (and the vessels that feed it), cut it up into segments, hook it together with titanium and make a jaw. He can also take part of a scapula and make a palate.
That means that patients who've had surgery for cancers of the head and neck do not have to be completely disfigured, that they can eat and talk normally. In the two years he's been at the University of Arkansas for Medical Sciences, he's done 114 of these microvascular procedures — hooking up the vessels to feed what are essentially transplanted, but not foreign, bones.
It's complex surgery on an area of the body that Moreno finds "fascinating" and "beautiful."
The Chile native did three fellowships at M.D. Anderson (including thyroid cancer and surgical endocrinology) — nine years of postgraduate training. "At that point," Moreno said, "my dad was like, 'when are you going to get a real job?' "
There are five head and neck surgeons at UAMS, but Moreno is the only one doing reconstruction, and half of his practice is devoted to that.
Head and neck cancer is associated with smoking and drinking, and UAMS sees "a fair amount of patients with stage 4" tumors. Patients may progress to that stage because, contrary to what one would expect, cancer of the mouth is "not that painful. It's a little sore that doesn't go away. If [patients] go see a primary care doctor not familiar [with tumors], they may put them on antibiotics."
Non-smokers and non-drinkers get head and neck cancer too — the incidence rate among these patients "has skyrocketed" in the last decade, Moreno said. Doctors know that the sexually transmitted human papillomavirus — which causes cervical cancer in women — plays a role. These patients respond better to chemo and radiation and thus have a better survival rate than those whose cancer stems from tobacco and alcohol use.
Speech pathologists play a vital role in the life of patients who've had reconstructive surgery, Moreno noted. The reconstructed jaw or mouth has no nerves and hence no feeling, so patients have to learn to compensate.
While at M.D. Anderson, Moreno learned a technique of operating to relieve lymphedema. It was a procedure he thought he'd never use again. But when he arrived at UAMS, Dr. Suzanne Klimberg, a breast oncologist, asked if he could do the procedure. While head and neck cancer is his "day job," he says, he is also working with Klimberg to bring the surgery, to relieve what is a common unpleasant aftereffect of breast surgery, to UAMS. The surgery isn't covered by insurance (though, Moreno noted, it's the standard of care in Italy); Moreno has been awarded a grant that will allow him to research, and pay for, the technique.
Edward M. Penick III, 35
Cataract surgery "is one of my passions," says Edward (Ted) Penick, something other doctors have observed, if the high vote count for Penick is any indication. Penick has been in practice for five years with Deer Penick Eye Clinic and TLC LASIK center, a 10-surgeon business that Penick says is the busiest eye center in Central Arkansas. He does around 30 surgeries a month.
Most of Penick's patients are older — in the 70s and up — and when this reporter asked how he assures his patients he's not too young to take a scalpel to their eyes, he acknowledges that "with surgeons, they don't want to see a young pup." But, he said, "The gray hair on my sideburns has helped."
Ophthalmology was a last-minute decision in his case, the Little Rock native said. He thought about being a primary care physician, but the opportunity to do surgery, and the innovative technology — he uses 10 different types of lasers in his work, each affecting a different kind of tissue according to its wave length — won him over. (For example, he described the YAG laser surgery, a treatment for narrow angle glaucoma, as causing a "miniature explosion" in the eye.)
Ophthalmologists get hugs, he says, from patients who thought they'd never be able to see so well, who'd quit socializing because their cataracts had blinded them. "It's such a rewarding service to patients."
The nature of the ophthalmological practice means doctors get family time. Penick and his wife, Jill, have children 5, 3 and six months. Already, he's coaching his son's basketball and baseball team. His specialty was "a really good choice and I've had no regrets."
Scott William Rypkema, 40
Coronary artery disease
Scott Rypkema, who joined Heart Clinic Arkansas in 2006, is concerned about the future of health care in America. If fully enacted, Rypkema says, the Patient Protection and Affordable Care Act signed into law in 2010 "will radically change how care is delivered. With the lack of resources to pay for everything, I think rationing is coming." He believes that procedures could be denied, for example, to people over a certain age. There already is a kind of rationing, by health insurance companies, he says, "if patients don't fit into a nice little category."
"I'm a pretty firm believer in trying to come up with the best treatment plan for that individual patient" and he will take it to the mat if insurance companies deny the type of care he wants to deliver. Usually, he's successful.
Rypkema is a native of Des Moines, Iowa, and after an internship residency at Barnes-Jewish Hospital at Washington University Medical Center, he did a brief stint as a hospitalist. He came to the University of Arkansas for Medical Sciences to do his cardiology fellowship, where he trained in nuclear perfusion, a more accurate stress test using a radiocative trace in the blood flow.
The "greatest thing" about cardiology, Rypkema said, is to be able to help people through their problems and illnesses and seeing what a difference you've made. ... Patients become like family members almost."
Matthew Steliga, 37
There's a lot of business for Matthew Steliga in Arkansas, unfortunately, thanks to the state's high rate of lung cancer. He came to the University of Arkansas for Medical Sciences two years ago after completing training in minimally invasive chest surgery at M.D. Anderson and the Texas Heart Institute in Houston.
"What I like best about my practice is we see a lot of variety," Steliga said, "from early stage small tumors to more complex tumors. We are able to help a lot of people with lung and esophageal cancer." The doctors in the multidisciplinary team he works with are "excellent," he said, and the nurses "top notch."
Steliga's claim to fame: He was able to do UAMS' first thoracoscopic lobectomy and segmentectomy, minimally invasive surgeries to remove lung cancers. The procedure requires only a small incision — 4 to 5 centimeters — and smaller instruments, guided by a camera. "It's a very good option for lung cancer," Steliga said. There's less post operative pain and fewer complications and the patient can leave the hospital and get back to normal activities more quickly.
These less invasive surgeries are also a good strategy to operate on people not strong enough to have their chests cracked open.
Steliga presented his improvement on a surgical procedure to deal with infection this summer at an international conference. He's looking forward to UAMS' participation in a multi-center clinical study on new lung cancer surgery techniques with such prestigious medical centers with Duke University, the University of Chicago, Washington University and Cornell. The study would look at two approaches to less aggressive surgical techniques that would preserve more lung function; UAMS is getting protocols approved now.
Do patients squirm when they see the surgeon who is going to operate on their lungs is 37? Not after he sits down with them and explains the treatment options "and their families really understand I know what I'm talking about," Steliga said.
Richard Wirges, 36
Russellville native Richard Wirges, a general surgeon who specializes in hands, says that though he gets paid to operate, he goes for the minimalist approach to healing a hand injury.
"I won't speak for anyone else, but my personal belief is [that we have] two main goals ... [to determine] what is it going to take to get function and comfort ... without subjecting you to other problems. It's not necessary to go straight to surgery."
Wirges got his medical degree from the University of Arkansas for Medical Sciences and did his general surgical internship and residency at Texas Tech University. He did a hand fellowship with Kleinert, Kurtz and Associates Hand Care Center in Louisville. "I wanted a specialty that I could feel like I could master," he said, adding with boyish enthusiasm, one that "had all the cool stuff I get to do," which is to work with "saws and plates and screws and drills."
Wirges has been in practice three years at OrthoArkansas, where he gets to see patients of all ages, which he says is perhaps the favorite part of his practice. "I tend to deal with pathologies that you can see improvement in" — carpal tunnel ailments, trigger fingers, traumatic injury to bones, tendons and nerves. He does not reattach hands (as UAMS surgeon Theresa Wyrick-Glover does) because of the time and medical team required.
To be a good doctor, Wirges says, one must be "a good listener." Training is one thing; knowing what to do and when to do it is another. Doctors must make sure patients understand what's going on and "are comfortable with what you are recommending."
Another benefit of his hand surgery practice: He gets to spend more time with family. He and his wife have three children ages 7, 4 and 18 months. His field gives him some "protected personal time, quality time."
Theresa Wyrick-Glover, 34
Hand injury, arm injury
Theresa Wyrick-Glover has the number of Leeches U.S.A. on her phone's speed dial for quick access to creatures that will suck blood. Leeches aren't everyone's favorite worm, but they come in handy when you're trying to keep a reattached finger alive and healthy.
Take the patient from Louisiana. He was playing basketball, went for a layup and sailed through a plate glass door. He cut all the nerves and arteries going to the arm. "He's a great kid, very driven," Wyrick-Glover said, and when he had to have leeches on his thumb, "he thought it was the coolest thing ever." An LSU fan, he separated his leeches into LSU and Arkansas leeches; he and the friends who came to see him said the Louisiana leeches won.
What leeches do, the Arkansas Children's Hospital surgeon explained, is secrete a blood thinner to prevent clotting and venus congestion; it sucks the bad venus blood out and lets the good arterial blood flow.
There are not many places like Arkansas Children's Hospital, Wyrick-Glover said, that have the ability to put fingers and hands and arms back on. Her work there "allows me to do very complex cases that often you don't see in private practice."
Wyrick-Glover has been at Children's for two years; it was just after she started that she treated two youngsters with hands mangled in lawnmower accidents. "We did an amazing reconstructive surgery, and they're playing baseball," she said. It was so remarkable TV's "700 Club" did a five-minute segment on it.
Wyrick-Glover earned her medical degree from UAMS and did a fellowship in hand and upper extremity surgery at Thomas Jefferson University in Philadelphia. (She found that people communicate differently there. When she was presenting a patient who she said had been in a "car wreck," the other doctors looked at her curiously. What? You mean a vehicular accident?) "The thing that I was most pleased to bring back" to Arkansas, she said, was digit replantation surgery, the ability to put fingers back on the hand, using sutures "smaller than the hair on your head" to connect blood vessels and nerves. Post-op, patients head for the hospital's "Tropicana Room," which is kept at above 80 F., to keep blood flowing in the replanted digit, and must not smoke or drink caffeine, which are vasoconstrictors.
The slender 5'7" doctor also enjoys "being able to teach residents and medical students" and show them "that you don't have to be a strong football-type guy" to be an orthopedic surgeon.
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