Top Doctors 2010: The Evolution
Medicine keeps moving forward, thanks to practitioners such as these.
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(To download the complete 2010 Top Docs list, click here.) (932KB)
The bad news: Conditions such as diabetes, high blood pressure and heart disease—not to mention a fair amount of mental stress—are on the rise. The good news: They’re more manageable and treatable than ever. Here’s what several of the most respected physicians in the state have to say about our health and their help. It should make you feel much better.
(Note: The physicians named in the Top Doctors list earned the greatest number of nominations in a survey of their medical peers. Physicians profiled received the most votes in their respective categories. Many excellent practitioners did not make the list. Their exclusion should not diminish their fine reputations.)
With 25 nephrologists and 11 nurse practitioners, Nephrology Associates is one of the largest practices of its type in the Mid-Atlantic. Named an exemplary practice in 2008 by the national Renal Physicians Association, Nephrology Associates is led by Robert Cox.
Perhaps the biggest change in Cox’s 30-plus years as a nephrologist has been the growth in the number of patients on dialysis. “When I first started practicing, there was one outpatient and one inpatient dialysis facility to cover the entire state, and there were only 100 patients on dialysis,” Cox says. Today more than 1,300 Delawareans are on kidney dialysis. There are 20 outpatient units, and every hospital in the state has an inpatient unit.
Why the dramatic increase? Reasons include a better understanding of kidney disease, greater availability of dialysis and more older patients choosing dialysis. But the biggest reason is an epidemic of chronic kidney disease in the United States that is related directly to the dramatic increase in diabetes, much of it caused by obesity.
According to Cox, of the 20 million Americans who have chronic kidney disease, 350,000 require dialysis. A number of advances have been made to treat these patients. Delawareans, for example, can now have kidney transplants at Christiana Care Health System through a program started with Nephrology Associates several years ago.
New, smaller dialysis equipment makes it more feasible for patients to dialysize at home, an option Cox expects more people will choose. Home dialysis not only allows a patient more freedom, it also encourages compliance, he says.
Cox expects that as soon as 2015, “wearable artificial kidneys” will begin to eliminate the need for cumbersome dialysis machines. The patient will be able to strap on the WAK and go about his or her normal routine while dialysis is performed continuously for eight to 12 hours.
All such advances in the treatment of advanced kidney disease are wonderful, but the real goal of Cox and his fellow practitioners is to keep patients healthy enough to avoid the need for dialysis or transplant in the first place. High cholesterol, high blood sugar and high blood pressure all contribute to kidney disease, so it is vitally important to control these conditions. Newer, improved drugs for these conditions help tremendously, Cox says—if people take them.
Page 2: Gilbert Leidig Jr. | Cardiology