Top Doctors 2012: Expert Spotlights

HEAD TRAUMA DOC 

Kathleen Bell, M.D.
Specialties: Physical Medicine and Rehabilitation
Practice and hospital affiliation: University of Washington Medical Center

Of note: Bell is the medical director of the Brain Injury Rehabilitation Program at the UW Medical Center—a position she has held for more than a decade—and is the director of the UW Traumatic Brain Injury Model System research program. She is also a professor of physical medicine and rehabilitation at the UW School of Medicine.
You treat patients who have suffered brain injury. What are your favorite success stories? I have learned that pessimism about recovery from brain injury usually is not warranted. One of my patients, an attorney who was severely brain injured after an assault, was unable to move, eat or speak for more than a year afterwards. Now, 10 years after her injury, multiple surgeries and treatment, she walks into the clinic and argues politics with me. While she will never totally recover, she has a satisfying and full life. Another patient was injured in a middle school football game and was in a coma for many months. With appropriate treatment, persistence and family support, he completed high school and is attending community college. He’s in a power wheelchair part-time, but, of course, that means that he “walks” a lot faster than any of us can. —SHEILA CAIN

CANCER COMBATANT 

Thomas K. Takayama, M.D.
Specialty: Urology
Practice: Bellevue Urology Associates and Washington Urology Associates
Hospital affiliation: Overlake Hospital Medical Center and Evergreen Hospital and Medical Center 

Of note: Takayama specializes in urologic cancer surgery, including robot-assisted laparoscopic radical prostatectomy for treatment of prostate cancer and robotic kidney cancer surgery. He formerly served as associate professor of urology at the University of Washington School of Medicine. He is a board-certified member of the American Urological Association, Seattle Surgical Society and Society of Urologic Oncology. 

What was your most surprising outcome? I remember a case [about four years ago] of a patient with extensive kidney cancer that had spread to the heart who underwent challenging surgery. I felt he had months to live. Over the years, he kept returning for follow-ups looking totally fine, without any residual cancer. It turns out he responded well to a brand-new drug that blocks cancer-cell growth [called Sutent]. I was so happy for him. I believe that the personal relationships between surgeons and their patients are key for assuring successful recovery and attaining optimum quality of life. I like to get to know my patients well and to follow them for years after their cancer surgery. —KAREN WEST

GUT INSTINCT

Richard Kozarek, M.D.
Specialty: Gastroenterology
Practice and hospital affiliation: Virginia Mason Medical Center

Of note: Kozarek is a regionally acknowledged gastroenterologist with a particular interest in pancreatic/biliary disorders as well as inflammatory bowel disease. He currently serves as a clinical professor at the University of Washington School of Medicine, and this year marks his 10th year on Seattle magazine’s Top Doctors list.
How would you describe your typical patient? I see two major patient types: those with inflammatory bowel disease (Crohn’s and ulcerative colitis), many of whom I have taken care of for 20 years, and those who need complex therapeutic endoscopic procedures. This may include taking stones out of a bile duct or pancreas, draining pancreatic cysts, or removing benign or early cancerous lesions from the GI tract.

Your approach to care often involves modifying behavior before considering medication or surgery. Any suggestions? Diet and exercise are tantamount to good health. Some things are simple to do: avoiding milk products in patients with lactose intolerance, and wheat and other grains in gluten-sensitive enteropathy. Others entail lifestyle changes. Stop smoking.
What led you to practice gastroenterology? Like many people, I had a mentor who convinced me that gastroenterology was a huge, continually evolving and interesting medical specialty. He was right. I continue to learn something every day. —S.C

BRAIN POWER

William Likosky, M.D.
Specialties: Neurology and Vascular Neurology
Practice and hospital affiliation: Swedish Medical Center, Minor & James Medical

Of note: In addition to being actively involved in stroke research, Likosky serves as the medical director of the Stroke and TeleStroke programs at the Swedish Neuroscience Institute, and is a neurologist with Minor & James Medical.

Are there any therapies you’ve had a hand in pioneering? A novel approach to excise clots from blocked arteries using catheters based on advanced MRI imaging.…We [at the Swedish Neuroscience Institute] are now part of a large international study using desmoteplase, a new clot-busting agent.…We will soon be participating with our cardiologists and interventional radiologists to deliver stem cells to the brains of persons who have incurred a stroke to replace damaged brain tissue and improve functionality.

How have you seen telestroke—the practice of diagnosing stroke patients remotely through videoconferencing—used successfully? We recently had a 50-year-old man arrive at an outlying emergency department due to a sudden onset of paralysis and inability to speak. We were connected [to that emergency department] using telestroke. We recognized he would benefit from an immediate use of a clot-busting drug, but would also need his clot extracted by the use of a catheter. We had him airlifted to Swedish Medical Center, where we [removed] the clot. Once these steps were taken, he rapidly improved and has since returned to normal activities. —S.C.

BREATHING EASIER

Bonnie Ramsey, M.D.
Specialty: Pediatric Pulmonology
Practice and hospital affiliation: Seattle Children’s Hospital

Of note: Ramsey is recognized as a national authority in pediatric pulmonology, with particular expertise in the treatment of the chronic lung disease cystic fibrosis (CF). She also serves as a professor of pediatrics at the University of Washington School of Medicine.

You recently worked on an exciting new treatment for CF. Can you explain? This last year, the clinical trials network I work with was involved in the development of Kalydeco—a pill cystic fibrosis patients take twice a day. The drug targets the underlying defect in CF—a genetic mutation—instead of just treating its symptoms. Right now, it works for about 5 percent of CF patients, but it could have a real significant impact.

One of your early CF patients recently participated in your Kalydeco study and has shown remarkable improvement. What was it like to see him again after more than 25 years? It was a very emotional experience for both of us. Rick is doing so well at age 50. When he was diagnosed, living to age 25 was considered a great success, and 50 was almost unheard of. In addition, Kalydeco had dramatically changed his life so that he is able to run and play with his kids and stay off IV antibiotics. I feel so blessed to have seen such a change in the overall survival and quality of life for patients with CF over the past 30 years. —S.C.

HEART HEALER

James S. Schneider, M.D., F.A.C.C.
Specialty: Cardiology
Practice: Eastside Cardiology Associates
Hospital affiliation: Evergreen Hospital Medical Center

Of note: Schneider specializes in diagnostic cardiology. He is former chairman of medicine at Evergreen Hospital and started the Nuclear Cardiology Department at Overlake Hospital Medical Center. He developed an expertise in nuclear cardiology after completing his master of science degree in nuclear engineering at MIT. He is board certified in cardiology, is a fellow of the American College of Cardiology, a clinical associate professor in the department of medicine at the University of Washington and a member of the American Heart Association.

What drew you to your specialty? I chose cardiology as my specialty because I enjoy seeing patients in the office long-term (I have followed some patients for over 30 years), and also helping with their emergencies in the hospital, especially stopping heart attacks with emergency balloon angioplasties and stents. Patients and the people I work with are the reasons I love my work.

What is the most satisfying aspect of your job? The honor to be able to take care of patients who face life-threatening illnesses and to help restore their lives both mentally and physically. —K.W.