Dr. Jihad Mustapha
What’s up, Docs?
The practice of medicine has become increasingly
segmented into subspecialties, which are
well represented in West Michigan.
By Marty Primeau and Tim McAllister
Photography by Michael Buck
There was a time when families relied on a general practitioner for all of their medical needs.
Today, the number of family doctors has declined as the ranks of specialists — and subspecialists — has risen.
Consider pediatrics. The number of pediatric subspecialists certified by the American Board of Medical Specialties is 20, ranging from neurodevelopmental disabilities to sleep medicine.
Ditto for internal medicine, with 19 subspecialties that include nephrology, critical care medicine and transplant hepatology.
West Michigan has its share of specialists and subspecialists, some of whom have become medical pioneers, improving the way procedures are done or making sure patients benefit from the latest advances in medical technology.
Is there a reason the practice of medicine has become to specialized?
“There are several reasons,” said Lody Zwarensteyn, president of Alliance for Health, the nonprofit health care planning agency. “One is that narrowing the scope allows some doctors to do more of the same things — and do them better. Practice makes perfect, so the more you practice, the better you’ll be.”
Saving a limb to save a life
Seven years ago, Dr. Jihad Mustapha gambled on a hunch.
Treating a patient about to lose her leg due to severe peripheral artery disease, the interventional cardiologist decided to try a device invented for something else.
It worked. He saved her leg — and perhaps her life.
Now doctors and researchers worldwide come to Grand Rapids to learn techniques from Mustapha and his team at Metro Health Hospital. He also travels around the country speaking about amputation prevention.
“Amputation is a barbaric way of treating artery diseases,” he said. “For many people it’s a death sentence. When a 75-year-old person loses a leg, the odds of dying within 18 months is 30 to 40 percent. It is important to keep the circulatory system intact. By preventing the loss of a limb, often you are saving a life.”
When plaque builds in the arteries that carry blood to the legs, the circulation slows. Mustapha performs artery and vein catheterizations to open vessels in the limbs to improve circulation. The device he originally used was created to clear clogged arteries leading to the heart.
“Back then, the technology we had was not sufficient,” he said. “I adapted it for the legs, knee and ankle. Now we are the place here at Metro where there is a new device in development,” he said.
Unfortunately, he said, demand for such procedures is growing with the increase of obesity and diabetes in the United States.
Mustapha’s efforts — he often works 18-hour days — have taken the specialty to a new level. “The support from my staff has allowed me to focus on patient care and to fine tune the procedure,” he said. “It also allows me to teach others. We are developing a community of physicians who are doing what we do. We are definitely making a difference.”
Dr. Dara Spearman
Specialized treatment for ethnic skin
Like most dermatologists, Dr. Dara Spearman knows all about treating skin cancers. The 31-year-old physician also keeps up with breakthroughs in rejuvenation procedures.
But her practice at Saint Mary’s Advantage Health Medical & Cosmetic Dermatology Center has a unique twist. Spearman specializes in ethnic skin.
“There are so few dermatologists of color,” she said. “As an African-American woman, I know a lot of patients feel more comfortable with a doctor who has a similar experience and understands their needs.”
While pursuing her medical degree at the University of Michigan, Spearman said she researched the unique qualities of non-Caucasian skin.
“The problems are definitely different,” she said. “Women with darker skin have less chance of cancer than Caucasian women, but they have more issues with scarring. Pigment changes are very common.”
Spearman recently had a patient come to her who had undergone laser hair removal on her face.
“You could see scarring in the shape of the laser head,” she said. “It’s about being aware and knowing the alternative procedures. At our facility, we are fortunate to have different types of lasers.”
While many skin rejuvenation technologies, especially lasers, were developed for Caucasian skin, Spearman said newer therapies are proving safe for darker skin.
Age-related therapies — especially the less invasive procedures — are in demand.
“Most women don’t want the down time of a face lift so they are turning to fillers and smaller procedures,” she said. “And they are also doing more maintenance. I am seeing women in their late 20s getting Botox to prevent wrinkles before they happen.”
Her advice is to always seek out board-certified dermatologists.
“Patients with ethnic skin should be sure that the clinician not only chooses devices that are safe and effective for darker skin types, but also uses appropriate settings to get maximum benefits with the least complications.”
Dr. Larry McCahill
Cutting edge of surgical oncology
Dr. Larry McCahill is not afraid to push the envelope.
He was the first surgeon to use the less-invasive laparoscopic surgery to perform a liver resection — partial removal of the liver due to cancer.
“More people have gastrointestinal cancer than either breast or lung cancer,” said McCahill, who has been director of surgical oncology at Saint Mary’s Lacks Cancer Center in Grand Rapids since 2009.
“And, unfortunately, we don’t have screening programs for many of these cancers, so they’re diagnosed at a later stage.”
To date, he has only been called upon to perform one laparoscopic liver resection.
“It was a unique situation,” McCahill said. “We cut off the blood supply to her liver six weeks before surgery. We were stepping out on a new limb there, because you’re not supposed to take out both blood supplies, but it was effective. Her liver started to grow on the other side, and after calculating that she had enough to live off, we removed three-quarters of her liver. She was home in about eight days. I was shocked that we could do that.”
The short recovery time is a huge plus for laparoscopic surgery.
“They can be challenging cancers, but patients can have an excellent recovery,” McCahill said. “Bodies have pretty amazing adaptive capabilities. But it’s certainly faster when you can do the whole thing laparoscopically.”
McCahill said Lacks Cancer Center is doing the same procedures as Mayo Clinic and the University of Michigan.
“The doctors who specialize in gastrointestinal cancer work as a team, so we’ve been able to develop some regional expertise,” he said.
“It opens the door for people to get their health care regionally. People can probably get 99 percent of the things they need done in town. And I think we’re really at the forefront.”
Dr. Chris Glisson
Diagnosing disease through the eye
You go to your ophthalmologist complaining of a vision problem. The standard diagnostic tests are run, but everything seems normal: no glaucoma, no cataracts, no macular degeneration. The doctor is stumped.
That’s when some patients are referred to Dr. Chris Glisson, a neuro-ophthalmologist with Saint Mary’s Health Care’s Hauenstein Neuroscience Center, who looks through the eye to see what’s happening in the brain.
“It’s a fairly new subspecialty with only about 600 in the country,” he said. “We’re considered the ‘court of last resort.’ Most patients who come to us have seen other physicians and specialists who can’t come to a conclusion.”
His area of interest begins at the optic nerve and the disorders of vision that arise from central nervous system disease. The optic nerve transmits visual information from the retina to the brain.
“The optic nerve is an extension of the brain,” he said. “People don’t see with their eyes; they see with the brain.”
Some patients are unaware they have a disease until it begins to affect their vision.
Glisson’s detailed examination — he looks at everything from medical history, diagnostic tests, a list of drugs the patient has taken and more — can detect diseases throughout the body, including brain tumors, diabetes and high blood pressure. All often are revealed in the patient’s eyes.
“Most of my patients tell me the exam and consultation is probably the most exhaustive they’ve ever gone though,” he said.
Glisson, who teaches at Michigan State University’s College of Human Medicine, said he was fortunate to be exposed to neuro-opthalmology as a medical student.
“Not everyone gets a chance to understand what we do. That’s what’s so great about having the MSU College of Human Medicine in Grand Rapids. “More students will find this specialty fascinating as they are exposed to it.”
Glisson was recently joined by Dr. Ronel Santos, making them the only two neuro-ophthalmologists in West Michigan. Both care for patients at Saint Mary’s Hauenstein Center.
Keeping athletes mentally strong
Sometimes being in peak physical shape isn’t enough. Today’s athletes often need mental training to help them perform at their best.
As a sport psychologist, Eddie O’Connor works with professional and amateur athletes to help them overcome mistakes and get through difficult times.
In other words, he’s a “mental toughness coach.”
At the Performance Excellence Center of Mary Free Bed Rehabilitation Hospital, O’Connor sees a lot of high school athletes with issues ranging from performance anxiety to eating disorders. Some may be experiencing a slump; others may be worried about the transition from high school to college. Many feel the pressure to win.
“When students come to me, they’re often frustrated,” he said. “I start out with a general description of the problem to figure out what the triggers are.”
They talk about the team atmosphere, coaching relationships, and how invested the student is in the sport.
“The more invested the athletes, the more nervous they can become,” he said. “The focus often shifts from concentrating on the present to worrying about the outcome. And when they start to worry about winning, they lose focus.
“I help them recognize what’s going on and help them focus on their own efforts and behavior.”
The benefits go beyond performing well in a game or event.
“When kids are struggling, they’re not getting an enjoyment out of the sports. Playing sports can enrich the high school experience, so I want to help make it fun again.”
O’Connor said he’s pleased to see the growth in sport psychology and an awareness to seek it out.
“The nice thing is, once they learn how to use the tools, they can apply them to school and other situations. They are valuable life skills outside of sports.”
O’Connor also is director and chief psychologist of the Pain Center at Mary Free Bed, helping patients with pain get their lives back.
Dr. Brian Lane
In the future, will all surgery be done using robots? Possibly. But in the here and now, Dr. Brian Lane is using the da Vinci Surgical System to perform more accurate, less-invasive procedures.
“The da Vinci is awesome,” said Lane, a urologist with Spectrum Health. “It’s a surgical robot that gives enhanced visualization and magnification. It helps us see better.”
Another thing that’s very helpful is that the instrumentation is “wristed,” he explained. “It’s articulated. So instead of just having the instruments go in one direction, you have nine degrees of freedom. It basically lets the instrumentation mimic what the human hand can do.”
The da Vinci robot is catching on.
“Now robotic surgery is expanding,” he said. “The first surgery was prostatectomy, and I do more of those than anyone else in western Michigan. But we also do kidney surgery, the gynecologists do ovary and uterus surgery, even our cardiothoracic surgeons and colorectal surgeons at Spectrum Health do robotic surgery.”
Sorry, science fiction fans, but the robots will not be taking over anytime soon.
“I call it robot-assisted laproscopic surgery instead of robotic surgery for that very reason,” Lane said. “When you say ‘robotic surgery,’ people think the robot is doing all the work. But the robot can do nothing without my direction.”
Lane does forecast an expansion in the use of robot assistants.
“I think it’s going to move into just about every surgical discipline there is,” Lane said. “Because of the improved visualization, instrumentation and the magnification, it’s usable anywhere. There could even be uses in ear, nose and throat surgery for very delicate work.”
Lane has even thought of using the da Vinci robot to create something for next year’s ArtPrize.
“It would be a great collaborative effort between all the surgical disciplines at Spectrum who use the robot,” Lane said. “Most hospitals don’t have that.”
Treating a silent epidemic
Pelvic prolapse is a common condition affecting as many as one in three women in the United States.
Yet it’s often dubbed the “silent epidemic.”
The condition occurs when muscles and ligaments supporting a woman’s pelvic organs weaken, allowing those organs to slip out of place.
Dr. Samir Hamati
“Women are embarrassed to talk to their doctor about this,” said Dr. Samir Hamati, the new medical director at The Pelvic Prolapse Correction Center of Michigan in Grand Haven. “And often when a woman does go to her primary care physician, she is told that pelvic prolapse is just part of growing old. As a result, many women are suffering in silence.”
Early stages can be treated with medication or such lifestyle changes as weight loss and Kegel exercises. But Hamati said that by the time most women seek help, they already are at stage three or four with symptoms that affect bladder, bowel and sexual intercourse. Surgery is often the only treatment in severe cases.
While traditional vaginal surgery has had complications, Hamati has been using the da Vinci robotic surgery system since 2006, achieving positive results with fewer problems.
The da Vinci uses 3-D, high-definition vision and miniaturized, wristed instruments designed to help doctors take surgery beyond the limits of the human hand.
“It’s much more precise and minimally invasive,” said Hamati, who has been a gynecologist for more than 25 years. “And because the hand is not inside the body, there is less trauma and adhesion — and also less hospital time for the patient.”
Hamati said his goal at the center, which is part of the North Ottawa Community Health system, is to make women aware of the importance of pelvic exams.
“Pelvic prolapse is something that affects a woman’s quality of life,” he said. “It should not be ignored.”
Solving the dilemma of childhood obesity
First lady Michelle Obama isn’t alone in her quest to help overweight kids. Since last year, researcher Joe Eisenmann has been investigating the problem at Helen DeVos Children’s Hospital Healthy Weight Center in Grand Rapids.
Joe Eisenmann, PH.D.
His patients range from ages 5 to 17, with a body mass index greater than the 95th percentile in their age and sex.
“Patients are referred to us from their primary care physicians,” Eisenmann said. “Their physicians should have tried some sort of intervention with them, trying to change key lifestyle behaviors such as physical activity and diet.”
After the referral, the child is subject to a grueling two-day clinical assessment.
“They’re measured from head to toe,” Eisenmann said. “They do a medical examination, a physical examination, and take an extensive medical history. Then there’s a psychosocial evaluation by a medical social worker and a pediatric psychologist, looking for anxiety or depression. They’re seen by a registered dietician.”
Information is gathered about dietary habits, dietary patterns and consumption of certain food groups.
“They’re seen by a pediatric exercise physiologist,” he said. “That person does an assessment of physical activity habits and patterns, also exploring barriers to physical activity. Then they exercise test them, test lung and heart function and do an analysis of body composition. It’s quite extensive and very comprehensive.”
Overweight children can develop diabetes as adults.
“A big abnormality is pre-diabetes,” Eisenmann said. “I want to know what percentage of our patients have pre-diabetic conditions, and look at associations between certain lifestyle characteristics and family behaviors.”
Eisenmann’s goal is to get a little closer to finding a cause or a trigger for childhood obesity.
“Not only is it a clinical program, but it’s a research program, as well,” Eisenmann said.
Parents aren’t off the hook, he said.
“This is really a family intervention. Parents are the gatekeepers. They make most of the decisions.”
Dr. Daniel Maison
Relieving a patient’s suffering
The good news: Americans are living longer.
The bad news: Many are living with complex and serious illnesses.
And those illnesses often are accompanied by pain, stress and a plethora of miserable symptoms.
Palliative care is a specialty designed to help such patients feel comfortable while they are being treated.
“For instance, a cancer patient undergoing chemotherapy with the expectancy of healing often is dealing with nausea and fatigue,” said Dr. Daniel Maison, a palliative care specialist with Spectrum Health Group. “It’s our job to keep the patient comfortable.”
Often confused with hospice, palliative care can be an option for patients at any age and at any stage of life expectancy — and it can be provided along with treatments that are meant to cure.
And as people with chronic or difficult-to-control conditions face medical choices, the palliative care specialist helps both the patient and family understand everything that’s going on.
“That is a big focus of our care,” Maison said. “When folks have big decisions to make, we want them to know all the options.”
He said palliative care specialists rely on input from the entire medical team, including physicians, pharmacists, nurses, psychologist, social workers and others, to formulate a plan of care.
“We don’t talk about right or wrong. We provide them with information.”
A relatively new specialty, palliative care has been practiced in other countries for several years, said Maison.
“Fifty years ago, people weren’t living as long as they are now,” he said. “Advances in medicine mean people are living longer, but the illnesses they face are more complicated.”GR