Top Docs: Profiles 2008

Steven P. Ringel, M.D.
Neurologist, Professor of Neurology
University of Colorado Hospital
Specialty Neuromuscular medicine
Practicing since 1975

Specialty description
“I take care of diseases of the nerve and muscle. I also see people with general neurological disease, but my real field of expertise is in all these nerve and muscle diseases. I’m a clinician and pathologist of muscle.”

Most common disorders
Amyotrophic lateral sclerosis (Lou Gehrig’s disease), muscular dystrophies, peripheral neuropathy

Why did you choose this specialty?
“I was trained as an internist, and I was very interested in immunological disease—this field of neurology has some immune disease. Secondly, it really appealed to me to be able to examine a patient and then look under a microscope to see what was wrong with their muscle biopsy—you get that correlation.”

Why do you like working in academia?
“An academic life is a wonderful life. Since you’re in the research world, you also get to see new breakthroughs and sometimes participate in them. It’s like you’re a student forever.”

What’s your favorite part of your job?
“Life is a terminal illness—everyone eventually has something. You learn how to help people, you always instill hope, and you do what you can do to help them. It’s the healing arts. Half of medicine is knowing people, liking them, and helping them through these crises.”

David A. Gilmore, M.D.
Emergency Medicine
Physician, Toxicologist
Director of Toxicology, Emergency Department at Exempla St. Joseph Hospital
Specialty Medical toxicology
Practicing since 1991

What is medical toxicology?
“It’s a huge field that covers drug overdoses, medication complications, and occupational exposures—Rocky Flats and oil refineries would come to mind—among other things.”

Most common disorders
Medication complications, medication interactions or nonallergic reactions, drug overdose, snakebites

Why did you specialize in this field?
“I did a couple of rotations in medical toxicology, and that’s when I decided to make that my specialty. It’s a lot like a detective story. Things are not always straightforward, and so you have to talk to the patient, and the patient’s family, and their other doctors, and we look at their list of medications. It’s intellectually challenging to sort through.”

When should a patient see you?
“Call your local poison control center. They can help you. You can call in and say, ‘My kid just ate a tube of lipstick. Is that a big deal?’ No. Give them a piece of pizza and they will be fine. But if a kid just ate one of grandma’s blood pressure pills, the answer is to call the ambulance.”

What is the best part of your job?
“We’re not quite as exciting or nearly as beautiful as the people on TV, but it can get pretty strange and there are times when the multitasking that goes on is very much a medical art form rather than a science. The best part is that most toxicology cases turn out well.”

What is the hardest part of your job?
“Toxicology is a subspecialty where there are a lot of reports of interactions and reports of problems—we call that anecdotal medicine—and sometimes there is not a body of scientific medicine that connects you to what the patient’s problem is. You have to sort through things based on your experience level rather than hard evidence.”

Neale R. Lange, M.D.
Critical Care Physician, Pulmonologist
St. Anthony Central, Parker Adventist,
Summit Medical Center, Alpha Sleep
Specialty Sleep medicine
Practicing since 1999

Specialty description
“I work with people with all forms of sleep disorders to help improve their sleep, to help them feel better, and to improve their function in today’s environment. It’s tough—most people I meet don’t have all that much time to sleep.”

Most common disorders
Obstructive and central sleep apnea, parasomnia, insomnia, narcolepsy, idiopathic hypersomnia, restless legs syndrome

Why did you choose this specialty?
“We had exactly one week to become familiar with sleep medicine during my specialty training. I walked in on day one and the neurology professor who ran the sleep lab said to me, ‘What are your goals?’ The next day, I said, ‘To be quite honest, my goal is that the minute I finish this rotation I’m leaving to go to South Africa. Is there any way you can help me to move my internal body clock eight hours over the next four days so that when I arrive I don’t have any jet lag?’ So we worked together with melatonin, a sleep schedule, and a bright light box. I wore dark sunglasses at 2 p.m. in the afternoon, and I had to wake up at 3 a.m. and sit in front of this bright light, and there was nothing to do, so I started to read about sleep medicine and absolutely fell in love with it.”

What’s your favorite part of your job?
“I regard sleep as the other 30 years of people’s lives. It is now apparent that what happens when people are asleep is of great significance to how they function during the day, how their memory works, how their mood is, and many common medical disorders like hypertension and depression. I get great satisfaction out of helping people sleep.”

Jean Kutner, M.D.
Internist
University of Colorado Hospital
Specialty Hospice and palliative-care medicine
Practicing since 1997

Specialty description
“We care for people—and their families—who have advanced illnesses or life-limiting illnesses. The focus is on maximizing quality of life and providing care that is consistent with that person’s goals and values.”

Most common disorders
Everything from heart failure to advanced cancer and emphysema

Why did you specialize in this field?
“If I look back, I think it was a culmination of what got me into medicine in the first place. My initial interest in medicine was around ethics, and particularly ethics of medical decision-making. I was actually told as an undergrad that if I wanted to do medical ethics I sure as heck better get an M.D., because you’ll have more influence.”

When should a patient see you?
“People don’t start investigating hospice and palliative care as soon as they could benefit from it. We can be most helpful with people earlier, especially if they are having symptoms that are not being adequately controlled. The goal is to really maximize quality of life.”

What is the best part of your job?
“The relationships that we develop with the patients and their families. If we can make what is inherently a difficult time in somebody’s life better, then that makes it all worthwhile. In some ways, it is going back to the roots of medicine. We treat the whole person.”

What is the worst part of your job?
“It can be emotionally draining. I think everyone who works in this field needs to have ways to support themselves and each other.”

What do you want patients to know?
“Hospice and palliative care is growing rapidly because there is an increase in the period of time that people are living with disabilities and chronic illnesses. We have turned some previously fatal diseases into chronic illnesses. People can receive palliative care while continuing their other treatments, like chemotherapy.”

Laurent Lewkowiez, M.D.
Cardiologist
Denver Health and University of Colorado Hospital*
Specialty: Clinical cardiac electrophysiology
Practicing since: 2000

Specialty description
“Cardiac electrophysiology is electrical work for the heart. Cardiologists do plumbing. EPs do electrical. We basically treat arrhythmias—inappropriate heart rhythms—in one of two ways: by implanting devices such as defibrillators and pacemakers, and by doing procedures (called cardiac ablation) with a catheter to prevent short circuits and runaway heartbeats. Ultimately, we’re restoring patients to a normal, regular heart rhythm.”

Most common disorders
Atrial fibrillation, supraventricular tachycardia, ventricular tachycardia, sudden cardiac death

Why did you specialize in this field?
“A family member had a heart condition that required this procedure when he was a teenager. I was 18 and we were running, and I remember his heart rate was racing at something like 300 beats per minute. That was the first time I realized something was wrong. He couldn’t quite keep up, and he had a good reason why he couldn’t keep up. That’s how I got interested in EP.”

When should a patient see you?
“If you are having arrhythmias and your symptoms are not controlled, then you should seek a specialist. And a specialist for arrhythmias is a cardiac electrophysiologist. You don’t want me taking care of your bunion, but if you have ventricular tachycardia or atrial fibrillation, I’m the person to do it.”

What is the best part of your job?
“It is one of the very few fields in medicine where you actually cure people. Once you are successfully treated with cardiac ablation, your arrhythmia is gone for good.”

What do you want patients to know?
“I think the common mistake is that people believe or are told that there is nothing else that can be done, that there is no therapy for what they have. A lot of times we have people who come to see us who could have been cured five years earlier and they didn’t know that the therapy was available.”

David K. Manchester, M.D.
Medical Geneticist
Children’s Hospital, Children’s
Hospital multispecialty clinics, Western Slope regional clinics
Specialty Medical genetics, specializing in pediatrics
Practicing since 1977

Specialty description
“We take new genetic information and translate it into diagnoses and clinical practice. That involves diagnosing rare and often not-very-understood disorders at the molecular level.”

Most common disorders
Developmental disorders, mild to severe forms of intellectual disability, children with birth defects, families with specific heritable conditions

Why did you become a doctor?
“I left home when I graduated from the eighth grade to be a cowboy. I wanted to be a rodeo cowboy, but the people who were rodeo cowboys explained to me that I didn’t have the athletic abilities to do that—and they were correct. I was very saddened by that, so I said, ‘What else might I do?’ And they said, ‘Well, you’re smart, maybe you might be a doctor.’ And my father was a doctor, so I said, ‘Well, I’ll give it a shot.'”

Why do you like this specialty?
“It’s a lot of fun if you like things that are intellectually challenging. And it’s a very people-oriented specialty. You meet incredible families, people that are flat-out saints.”

What have you learned from your years in this job?
“All these sad situations teach us about our humanity. They also teach us about our biology—one could call these ‘God’s experiments.’ These individuals are all trying to tell us something—their biology is different than your or my biology, but it’s different in a specific way. Many things we’ve come to understand about biology have come from these experiments in which children have had chromosomal rearrangements, because that’s a very quick way to map a gene.

The patients themselves, although very challenging, have so much to offer about themselves, about us, and what compassion ought to be.”