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Top Docs 2009: The Specialists

You need good medical care. How do you know who gives it? We asked the doctors who of their peers they’d trust enough to recommend to a loved one. Here are their picks.
(To download the complete list of 2009 Top Docs, go to page 6 and click on the link.)

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Valerie A. West, MD

Dr. Valerie West sees about 15 patients a day, and she enjoys spending a good deal of time with each one. “An endocrine history usually tells you more than a physical exam,” she says, “but, of course, you do both.”

Endocrinology is the area of medicine that deals with glands, which secrete hormones, which regulate everything from growth to metabolism to reproduction. Gland disorders can lead to such conditions as osteoprosis and diabetes.

Osteoporosis is characterized by a decrease in bone mass and density, causing bones to become fragile. West often treats osteoporosis with oral bisphosthonate medicines such as Fosomax, Actonel and Boneva, which slow bone loss. She’ll sometimes prescribe Reclast, a new intravenous drug that helps people who can’t tolerate pills. A stronger drug, Forteo, actually builds bone.

Why wouldn’t every patient want Forteo? Three reasons, says West. It requires an injection daily for one to two years. It costs a fortune if not covered by insurance. And the FDA has found, in studies of rats, there’s an increase in a rare bone cancer. “So far in people, that does not appear to be the case,” West says. But Forteo is still risky.

West is known for sincerity and patience. Diabetic adults need encouragement, not lectures. “Education is crucial,” she says. “Some things are difficult, like suggesting a healthy lifestyle change, but if patients understand what they have to gain from it—which is what I want to learn from my own physician—it’s more meaningful.

“With diabetes, the payoffs of getting good control are phenomenal, including decreased complications like kidney, eye and nerve problems, better immune function. And when sugars levels are corrected, people have more energy and can see better,” says West.

Osteoporosis is fairly common, and diabetes has reached a near-epidemic scale. But West is busiest tending to thyroid disorders and thyroid cancer. Hyperthyroidism (over-active thyroid) can cause a stroke or a heart attack. With hypothyroidism (under-active), patients can lose focus, feel cold or gain weight. Incidences of thyroid cancer, unfortunately, are on the rise. “It’s a national problem, though it’s true that Delaware is still among the top in cancer ratings,” says West. “You can wonder about all the chemicals here, but it’s speculation at best.”

Her suggestion “Do an exercise that’s enjoyable, easy and adaptable.”

West’s resources They include her fellow board-certified endocrinologists at The Diabetic Center at Christiana Hospital, which offers specialized care for patients with diabetes, metabolic issues and other endocrine disorders.

Page 2: Adolescent Medicine | Lisa Barkley, MD