Cheryl deSimone, MD
Director, Albany Medical Center (AMC) Department of Anesthesiology
Undergraduate degree: Saint Bonaventure University, biology pre-med
Medical School: Upstate Medical Center
Residency and Fellowship: Thomas Jefferson University Hospital in Philadelphia
Dr. Cheryl deSimone knew in high school that she wanted to be in a management role as a doctor. She briefly considered nursing, but was looking for the autonomy and decision-making ability that came with being a physician. It wasn’t until her medical school rotations that she decided anesthesia would be her career.
While most people are familiar with the term anesthesia, what many may not realize is that anesthesiologists don’t simply administer the pain blocker and leave the operating room. According to the American Society of Anesthesiologists, “As physicians, anesthesiologists are responsible for administering anesthesia to relieve pain and for managing vital life functions, including breathing, heart rhythm and blood pressure, during surgery. After surgery, they maintain the patient in a comfortable state during the recovery, and are involved in the provision of critical care medicine in the intensive care unit.”
What deSimone loved most about the field was the fast-paced activity in the operating room. And, wanting to work in obstetrics (without having to deliver children) allowed her to combine her passions. “I liked the area of obstetric anesthesia because it was just a wonderful area where it’s a wonderful experience being able to enjoy seeing women in childbirth,” she said.
Of course, women in childbirth are excited to see her, but they’re even happier when she leaves because, it means they are much more comfortable after having received their epidural.
As the Director of Anesthesia for Albany Medical Center for the past 18 years, she admitted she was nervous in the beginning of her career, but today more closely associates the feeling with high observation and acuity. “If I wasn’t nervous and I wasn’t careful than I wouldn’t be a good physician because I think you have to stay nervous every moment of every day to be conscious of what you’re doing,” she said.
Nervous, however, is a perfect word to describe what some patients feel knowing they will be under anesthesia. Comparing it to other areas of medicine, deSimone said anesthesiologists are concerned with potential allergies and what can go wrong.
“In childbirth,” she said, “we worry about a lot of extra issues because we’re dealing not only with the mother, but we’re also dealing with the baby. So whatever we do to affect the mother could potentially affect the baby, so we’re very careful and worry about two patients at the same time.”
Allergic reactions to anesthesia can vary from a bee sting-like reaction to malignant hypothermia. The former involves shortness of breath, hives and swelling; the latter is a “reaction specifically to anesthesia that some patients develop during a general anesthetic,” she said.
Without hesitation, she said the best part of her job is seeing the joy of childbirth and making a woman comfortable during it; a comfort deSimone has embraced herself. When asked if she had an epidural while giving birth to her two children, she said, “Absolutely! There was never a doubt in my mind if I would get an epidural; I never realized how much it hurt until I had my first child.”
Many times, you will hear women say that it was “too late” for an epidural to be administered and had to go through labor drug-free. deSimone explains it has more to do with the movement of the mother than dilation.
“Once you’re starting to push the baby out, although it’s uncomfortable, it’s very difficult to stay still to put an epidural in and you’ve already gotten through almost the most painful part of the delivery process.”
For those hesitant to embrace the idea of anesthesia, she said that anesthesiologists are trained and schooled the same way all physicians are.
“Anesthesiologists are well-trained, they’ve dedicated a long residency process and years of education to taking care of patients under anesthesia,” she said. “The safety mechanisms that are in place now and the monitoring that is in place now has made it a relatively safe delivery system.”
An anesthesiology residency consists of one year of an internship, followed by three years of anesthesia training. Additionally, many people then go on to complete fellowships totaling a nearly five- year process post-medical school.
During training, anesthesiologists learn how to put patients to sleep, all the techniques of monitoring, all sorts of regional blocks to help alleviate pain, how to do anesthesia for cardiac neuro surgery and all different types of surgeries that involve different types of anesthetics.
When asked what makes a great doctor, DeSimone said, “Somebody that has the passion for what they love and has a sympathetic ear and has the ability to change course when they think they’ve made a wrong decision and then make a right decision.”
Undoubtedly, she fits her own definition of a great doctor.
Joshua King, M.D.
Plastic Surgeon, Albany Plastic Surgeons, PLLC
Undergraduate degree: Union College, biology
Medical school: Albany Medical College
Residency: Albany Medical Center Hospital
Fellowship: Baylor College of Medicine
For over a decade, Dr. Joshua King has been developing his practice in an area that has become increasingly popular thanks to celebrities and reality television – plastic surgery. However, this field is much more complex than just nose jobs and face lifts; it’s more about changing a person’s outlook on life.
As part of Albany Plastic Surgeons PLLC, where he’s been since 1995, King practices with Dr. Debbie Kennedy and an experienced staff, some of whom have been there for over 20 years. King focuses his practice on reconstructive surgery and body contouring procedures for patients that have undergone extreme weight loss.
“Once they lose a hundred pounds or more, they have sort of an oversized skin suit,” he said. He job is to contour their bodies by removing excess skin from the torso, arms, thighs and other areas that need reshaping.
Originally from New Jersey, King knew from a young age he wanted to be a doctor. Coming from a family of dentists, he grew up surrounded by medicine and didn’t waste any time getting started in the medical field.
“In high school I won the RPI medal, which allowed me to study college level chemistry,” he said.
King soon learned of a joint undergraduate and medical program, which gave him the chance to do two years of college at Union and four years at Albany Medical School. This cut what would have been eight years of school down to six.
Following a general surgery residency at Albany Medical Center and a hand surgery fellowship at Baylor College of Medicine in Houston, Texas, King did another residency at Albany Med, this time focusing purely on plastic surgery. He has been practicing the specialty exclusively since then.
“Plastic surgery is a field with an amazing variation of problems,” King said. “The scope is incredibly vast.”
With a range from birth defects to hand surgery to reconstructive surgery following a trauma or disease, not to mention cosmetic procedures, King notes that each area varies in its complexity. This is something he particularly enjoys about the field, as well as being able to operate on all parts of the body.
“I’ve always loved puzzles and working out brain teasers, so that’s what really drew me in.”
In addition to body contouring, he also performs a large amount of reconstructive surgery for patients who have been diagnosed with skin cancer. He’s become highly skilled in creating skin flaps to replace tissue that needs to be removed due to treatment purposes.
While each particular surgery brings its own nuances and intricacies, it’s the work he does with cleft palate patients that is one of the most difficult surgeries.
“You are working in a one-year-old’s mouth, which is a very tight space to maneuver in,” he said. “Technically, it’s the hardest to do.”
Arduous as it may be, it doesn’t keep King from performing the surgery regularly. He has even traveled to the Dominican Republic on three occasions to perform charity surgeries for children suffering from the birth defect.
King is dedicated to helping his patients outside of the operating room as well. He is one of the few plastic surgeons in the area who acts as an advocate for insurance coverage and also gives lectures at weight loss support groups.
“These people are highly motivated and are going through a real lifestyle change,” he said.
While each surgery is memorable in its own way, there are a few that stand out in King’s mind. He worked as the lead surgeon with a team of doctors who successfully separated conjoined twins that were connected at the abdomen and shared a liver. He also successfully reattached a man’s hand after a traumatic accident.
“The man’s sleeve got caught in a miter saw and it cut his hand off at the wrist,” he said. “I was able to reattach the tendons and ligaments and he now has full use of it again.”
Now in his 15th year of practice, King has worked hard to create an environment in his office that is both private and comfortable, two very important elements for patients who are undergoing plastic surgery. He has also made significant bonds with his patients that have lasted over the years.
“I see cleft palate children who I worked on as infants that are now in high school, and it’s a great feeling,” King said. “You really build lifelong relationships with reconstructive patients.”
King finds his profession and chosen specialty extremely rewarding, noting how fulfilling it is to restore function to parts of the body that were removed by trauma or cancer treatment incisions.
“Sometimes the rewards are huge, but sometimes they are as simple as making someone more confident in their daily lives and relationships.”
Howard S. Malamood, M.D.
Gastroenterology, Saratoga Schenectady Gastroenterology Associates
Undergraduate degree: Queens College, biology
Medical school: Albany Medical College
Residency: Albany Medical Center
Fellowship: Albany Medical Center
As far back as he can remember, when he was just a kid in Bayside, Queens, Dr. Howard Malamood knew without a doubt that he wanted to add the initials, M.D. to his name. It wouldn’t be until years later, when he’d decide just what kind of doctor.
After graduating from Queens College with a degree in biology, Malamood made the move upstate to Albany Medical College. He stayed there upon graduation, where he completed his residency in Internal Medicine and his Fellowship in Gastroenterology. At this point, he thought he would return home to Queens, but love intervened.
“People from the New York City area, think you can’t live anywhere else, but I met my wife here and I stayed and I have no regrets.”
After completing his Fellowship, Malamood joined the Gastroenterology Department at Albany Med and became an Assistant Professor. He went on to become the Medical Director of GI Endoscopy at the Center and Director of the Gastroenterology Fellowship Endoscopy Training Program for Albany Medical Center College.
“I liked the teaching, but I like the combination of office medicine and patient care and procedures in the hospital a lot more.”
After 16 years at Albany Med, Malamood went into private practice, joining Saratoga Schenectady Gastroenterology Associates in 2002. The most common misconception of gastroenterology is that doctor’s focus only on the colon.
He said jokingly, “People think we sit in dark rooms and pass tubes in rectums all day. There is a lot more to gastroenterology.”
He treats problems that affect the upper and lower GI tract, as well as the liver, “We treat all sorts of diseases, ranging from acid reflux to ulcers to inflammatory bowel diseases and diseases of the pancreas.”
Dr. Malamood also has a special interest in esophagitis-gastritis, which is the inflammation, irritation or erosion of the lining of the stomach.
He is also the Medical Director and founder of the Esophageal and Motility Center at Ellis Hospital in Schenectady and has worked in the same capacity at Saint Claire’s in Schenectady and Albany Medical Center.
“At the Motility Center, we do special studies to evaluate certain disorders, reflux disease, different ways to treat and evaluate unexpected cough and reflux and swallowing abilities.”
But that is only a small part of what he does. Although work at the practice keeps him busy, he also has a full family life. He’s married to Dr. Amy Walsh, an Internist at Albany Medical Center, and they have five children. They call Guilderland home–many miles from where the boy from Bayside dreamed that one day he would become a doctor. Now that dream seems to have come full circle. In September, one of his sons started his first year of school at Albany Medical College.
“I think one or two others may be interested, too. I’m very proud.”
John Melbourne, MD
General Addiction Medicine
Medical Director at Conifer Park
Medical school: Hahemann Medical College, Maryland
Residency: Charlotte Memorial Hospital
A lot of has changed in the field of addiction medicine since Dr. John Melbourne began practicing medicine in the 1970s. Men and women were usually separated during the course of treatment, there weren’t groups for adolescents, and many formal programs we are now familiar with were not in place.
But that was almost 40 years ago. Today, at Conifer Park for instance, where Melbourne has been the medical director for the past 12 years, there are many different groups, as well as separate units for adolescents, adults and Hispanics. Conifer Park is a private residential chemical dependency treatment facility in Glenville that offers long and short-term care for addiction issues including alcohol, heroin, cocaine and methadone.
Addiction is nothing new, although formal education in the field is fairly recent.
“There was no education at medical school for addiction. We talked about the complications of addiction, like if you drank too much it would do damage to organs. We only learned about the end stage complications of addiction,” said Melbourne, who began his career as a primary care physician.
Early on, he saw a need that wasn’t being met in addressing patients who were addicts while he was a primary care physician. As a result, he started setting up outpatient appointments and got consultations for those patients. He began doing detoxification and so began his specialty in the field of addiction medicine.
Prior to his current position at Conifer Park, Melbourne practiced in Danbury Hospital, CT, where he worked in outpatient clinics and became the detox unit director. In the time between his medical training and his employment in Connecticut, Melbourne was involved with a church-sponsored clinic program in Charlotte, NC. While there he met an alcoholic man who came to the clinic for financial advice. The man, debilitated by his disease, soon began to dress better and was looking better overall.
“He was an alcoholic that made dramatic changes. We offered him non-judgmental care,” said Melbourne.
He remembers vividly at Christmastime that the man, who volunteered to help decorate the tree, was crying as he placed ornaments on it. He hadn’t done that since he was a kid when he ran away from home as a young boy. Remembering the significance of that patient’s actions touches Melbourne to this day.
Inspirational stories are wide-ranging in the field of addiction, and the doctor recounts another that has stayed with him. It involves a 94-year-old man who was brought to the ER by his family and left there.
“His family thought the man was senile and not capable of anything. He was actually intoxicated.”
After getting help from Alcoholics Anonymous (AA), the gentleman began leading AA meetings and even started ‘The Silver Foxes’, a program to help addicts 75 years of age and older. He lived for two more years, proving that age has nothing to do with recovery or one’s ability to give.
These days, Melbourne is active in both teaching and lecturing about addiction to various organizations and hospitals a few times a year. One of the most recent topics is about the drug buprenorphine (Suboxone), an opioid, similar to methadone, which is prescribed to aid in treating an addict. The drug is seen as having lower dependence-liability than methadone.
“It’s particularly useful for those new into addiction and who have the resources to be able to get to a doctor’s office,” said Melbourne. Because this drug is only available by prescription, many addicts may not be in a position to go to a doctor for it.
Although much has changed in the field of addiction medicine, sadly one aspect remains the same: drugs are still easily available to attain. According to Melbourne, you can walk into almost any high school, and get what you need if you know the right person.
Addicts are from all walks of life, all ages and at all socio-economic level of society. Addiction is a disease, manifested by a host of indicators, including a user denying that there is a problem in the first place. Many times, helping the user recognize the problem is the first step in getting the person treatment. Depending on the length of time an addict has been using, the time it takes to ‘get clean’ varies. The earlier a user gets into treatment, the chances for a positive turnaround is more likely.
An important thing to remember is that the longer an addiction goes, the longer the separation between the user and family. “The most important thing is to try and recognize the role that substances are playing. Be non-judgmental and get them into treatment,” said Melbourne.
For families in need of help, Melbourne points out that most counties have a Drug Abuse Council and local hospitals have resources for families of addicts. There are many 12-step programs including AA and Narcotics Anonymous (NA).
Melbourne’s most rewarding part of his job is when he’s working with a group of people that would otherwise been given up on by the medical community or their families.
“Sometimes you can really be a witness of someone finding themselves again,” he said.
William (Bick) Wanck, M.D.
Bick Wanck, M.D. & Associates
Undergraduate degree: Penn State, science & biology
Medical school: Temple Medical School
Residency: Syracuse Medical Center
Over the past few years, there has been a steady increase in people seeking psychiatric services. Dr. Bick Wanck of Bick Wanck, M.D. & Associates in Saratoga Springs thinks the reason is two-fold. Not only is there a growing social acceptance of mental health services these days (Wanck has even overheard dinner conversations between people comparing anti-depressants), but the upheaval in the economy has caused many people to seek out professional assistance for their anguish and their anxieties.
Luckily, there are professionals like Wanck who are there to help. You could even say it his life’s calling. Growing up in Pennsylvania, he was only 15 years old when he first discovered his interest in working in a “healing capacity”. Just a teenager, Wanck had a vision of himself setting up shop in an old farmhouse with a bunch of friends. And in 1989, after moving to the Capital Region and opening up his own practice, he fulfilled that vision by expanding his practice and relocating it to a farmhouse with a few other doctors.
“It’s the one area of medicine I felt most comfortable being a healer.”
The group eventually left the farmhouse and relocated to the south side of Saratoga near SPAC while recently opening a second location at 516 Washington Avenue in Rensselaer. There are about two dozen doctors working in the two different sites. Currently, he is in the process of launching an initiative that will develop the second site more fully.
There have been many changes in the field since Wanck finished his residency in 1982, primarily in the technology of psychopharmacology and the increase in information regarding genetics and epigenetics. “We’ve always been faced with the challenge of sorting out how much symptoms are due to nature versus nurture.”
Often, it can be both ways. While many patients suffer from a clear-cut genetic medical condition such as bipolar disorder that can be treated with medications, others endure ailments such as co-dependency, which is a condition manifested by anxieties over what others think of us and can often be mistaken for genetic anxiety. Even more problematic is the fact that co-dependency can sometimes co-exist with a genetic-based condition; in that case, treatment may involve individual and group psychotherapy, and some people find it helpful to add spiritual recovery.
And treating patients is what Wanck truly enjoys. From his early days in Princeton, NJ following his residency, where he ran a program at a private psychiatric hospital for the rich and famous, to his current practice focused on the not-so-rich-and-famous who suffer from anxiety and sadness, he has learned that empathy is much more important than sympathy. “It’s more about being pleasant without personalizing the other person’s experience. We don’t hold the person’s suffering; we stream it and work with the person on how to manage it effectively.”
In this day and age of over-prescribing and over-medicating, there has been a trend on shorter sessions and a focus on symptom resolution with prescriptions. Wanck’s wish is that psychiatrists in general spend more time talking to patients.
“I’m a strong proponent of the healing aspect of psychotherapy as a very important part of treatment process.”
His approach is to have an in-depth conversation with a patient before prescribing medication in order to determine how much a problem is attributable to physical as opposed to sociological factors. He also isn’t opposed to the use of natural remedies if there is evidence that they’re helpful. Wanck is also open to exploring information that his patients bring him from the Internet or television commercials.
“It has to be teamwork; we work on issues together.” In fact, he finds it helpful that people are more informed these days. “People have educated me at times,” he said. His only concern is people visiting chat rooms where there might be misinformation posted.
Seeing between 10-12 patients a day at intervals of 30 or 60 minutes a session, it’s hard not to wonder if the doctor feels drained by day’s end.
“Drained? I feel the opposite. I feel invigorated. The key is to be able to have empathy and work with people rather than take on their problems.”
One of his biggest challenges is not having enough time. “I love what I do and wish I had more time. I feel like an historian, being able to heal and grow with a person.”
-Mary Beth Galarneau
Questions are at the heart of quality medical care
It’s not surprising that people find it difficult to press physicians for more clear answers or more thorough analysis when they’re sitting in an examination room, wearing a paper gown. Still, it’s of the utmost importance to actively participate in your or your family’s medical care. Recent studies have found that patients receive incorrect diagnoses as much as 20 percent of the time and the wrong treatment half of the time.
Medical errors occur often because doctors aren’t able to spend as much time with their patients as they once could. In fact, according to U.S. government surveys, the average time physicians spend face-to-face with patient is 10 minutes or less–so it’s no surprise that information is missed. This is why it is so important for individuals to ask questions to their physicians, and to be their own healthcare advocates.
At Best Doctors, we see the impact of this every day. In a review of the consultation cases our company handled for a population of about 700,000 Americans in 2008, diagnosis and treatment decisions were either incorrect or inadequately supported more than half of the time. These included a range of conditions, from cancer, cardiac and neurological, to more routine ailments. Almost a third of cases featured insufficient work-ups, where additional testing was needed to make sound clinical judgments. Yet these tests were not done.
Nearly half of patients reported that they felt something was going wrong in their care, but weren’t sure where to turn for help.
It can be quite difficult to break down the doctor-patient barrier and to act as an advocate for you or your family’s medical care. In light of the number of misdiagnoses in the US, consider advice from the American Health Quality Administration (AHQA) when you meet with your doctor:
1) Be prepared – what are your health concerns, what do you need to understand more
2) Ask questions – what other options do you have, what else could be going on, what are the best- and worst-case scenarios
3) Be skeptical – consider validating your physicians’ opinion or getting a second opinion
By being a healthcare advocate, while it may be uncomfortable, you are improving healthcare quality where its needed most–making sure the diagnosis and recommended treatment are right.
Dr. Fritz Hofheinz is the medical director of Best Doctors, Inc., an expert medical consultation service offered as a workplace benefit and currently available to more than one million American workers. He blogs on a variety of healthcare issues at www.seefirstblog.com.