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Best Doctors 2000: Special Focus

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Lyme Disease
Ask five different doctors to describe Lyme disease, and you'll get five different answers. Often called the "Great Imitator," and commonly associated with up to 100 different symptoms, Lyme disease is a multistage bacterial infection, transmitted by deer ticks, that first results in flulike symptoms, joint pain, and fatigue. If you're fortunate enough to realize you've been infected -- more than 70 percent of its victims don't even know they've been bitten -- the disease is readily treatable with antibiotics. Absent treatment, the infection can lie dormant before returning in the form of late-stage symptoms such as neurological disorders, heart irregularities, and, most often, swollen knees or migrating joint pain. If the disease reaches this late stage undetected, it can be very difficult to treat. Currently, a fierce medical debate is raging over the merits of long-term treatment. While most doctors say that a 30- to 60-day course of antibiotics is sufficient to kill the infection, others insist that long-term antibiotic treatment is often necessary. Most infectious-disease specialists are concerned that extensive treatment is potentially dangerous, and are awaiting the results of current studies-in-progress. Manhattan infectious-disease doctors who specialize in Lyme disease are Laura Fisher, director of the Lyme Disease Center at New York Hospital-Cornell Medical Center (212-746-1771), and Christopher Busillo (212-238-0102) and Chester Lerner (212-238-0106) at New York University Downtown Hospital. In Westchester: Robert Nadelman (914-493-8865) and Gary Wormser (914-493-8865) at Westchester Medical Center. In Nassau: Eileen Hilton (516-470-6900), director of the Lyme Disease Diagnostic and Treatment Center, and Sunil K. Sood (718-470-3480) at Long Island Jewish Medical Center. In Connecticut: Eugene Shapiro at Yale-New Haven Hospital (203-688-4518) and Debra Adler-Klein at Stamford Hospital (203-325-0146). Two internists with particular expertise in treating the illness are Bruce Logan at Manhattan's New York University Downtown Hospital (212-608-6634) and Raymond Dattwyler at U Hospital, Stony Brook, in Suffolk (631-444-8364). In addition to infectious-disease specialists, many rheumatologists who treat patients suffering from arthritic conditions have become adept at recognizing the illness. Among the best are Thomas Argyros, director of the Lyme Disease Center at Lennox Hill Hospital (212-988-7680); in New Jersey: Leonard Sigal at Robert Wood Johnson Medical School (732-235-7210); in Connecticut: Robert T. Schoen at Yale-New Haven Hospital (203-789-2255). Recently, LYMErix, a new FDA-approved vaccine, has proven 80 percent effective in clinical trials. For up-to-date information on the vaccine and other issues, contact the American Lyme Disease Foundation at 914-277-6970 or visit its Website at www.aldf.com.

Asthma
All doctors are trained to identify and treat the symptoms of an asthma attack, but asthma is a chronic disease that requires long-term management, and treating it solely on an attack-by-attack basis can be unnecessarily expensive and ultimately ineffective. "The toughest job of an asthma specialist," says Dr. Michael Chandler of Mount Sinai hospital, "is not to identify or even treat the symptoms but to find and eliminate all of the overlapping factors—allergens, stress, diet, immunodeficiencies—that perpetuate the overall condition. Finding people who look at all the relevant factors at once is difficult, because these factors cross the specialty lines of pulmonologists, allergists, pediatricians, and internists." Pediatric allergist Dr. Paul Ehrlich concurs: "Look for someone who takes care of asthmatics day in, day out," he says, "someone who considers the entire picture and inquires about the family history, foods, pets, etc.; and also someone who is board-certified in their field of expertise." The top Manhattan internists specializing in asthma are David Posner at Lenox Hill Hospital (212-861-8976); Daniel Libby (212-628-6611) and Thomas Nash (212-734-6612) at New York Weill Cornell Center; Wilfredo Talavera at Cabrini Medical Center (212-995-6629); Jonathan Raskin at Beth Israel Medical Center (212-288-4600); Muthiah Sukumaran at New York University Downtown Hospital (212-732-7260); and Michael Chandler (also a certified allergist) at Mount Sinai Medical Center (212-486-6715). In the Bronx: Latha Menon at Bronx Lebanon Hospital Center (718-518-5581). In Bergen County, New Jersey: Assia Bromberg at Valley Hospital (201-796-2255). The top Manhattan pediatric allergists specializing in asthma are Paul Ehrlich at NYU School of Medicine (212-685-4225) and William J. Davis at Columbia Presbyterian Center (212-305-2300). In Brooklyn: Arlene Schneider at Long Island College Hospital (718-624-6495). In Bergen County, New Jersey: Ziv Harish at Englewood Hospital and Medical Center (201-871-7475). In Westchester: Allen Dozor at Westchester Medical Center (914-493-7586).

Prostate Surgery Aftereffects
While prostate cancer and the options for treating it are very much in the news (thanks, in part, to celebrity sufferers like Joe Torre and Rudy Giuliani), the side effects of prostate surgery, one of the most common early-stage treatments, still tend to be spoken of in whispers. Incontinence and impotence remain deeply troublesome issues for most men, and surgeons and oncologists are not specifically trained to treat these conditions. Yet there are urologists who specialize in the treatment of impotence and incontinence that result from radical prostatectomies. Incontinence can be treated with medication, exercises to strengthen the bladder, additional surgery, or even implants. Top Manhattan urologists who specialize in incontinence are Mitchell Benson at Columbia Presbyterian Medical Center (212-305-5201), Jerry Blaivas at New York Weill Cornell Center (212-308-6565), Steven Kaplan at Columbia Presbyterian Medical Center (212-305-0140), Jonathan Vapnek (212-241-7439) and Howard Schiff (212-996-6660) at Mount Sinai Medical Center, and Franklin Lowe at St. Luke's-Roosevelt Hospital (212-523-7790). In Queens: Albert Tarasuk at New York Hospital Medical Center (718-353-3710). In Nassau County: Jeffrey Layne at North Shore University Hospital (516-933-6060). In New Jersey: Michael Fleisher at St. Peter's Medical Center (732-613-9144). And in Connecticut: Jonathan Waxberg at Stamford Hospital (203-324-2268). The treatment of impotence caused by prostate surgery includes penile implants or mechanical pumps to aid erections, and the medication of the moment, Viagra. Top Manhattan urologists who specialize in this area are François Eid at New York Weill Cornell Medical Center (212-746-5473), Ridwan Shabsigh at Columbia Presbyterian Medical Center (212-305-0123), Arnold Melman at Montefiore Medical Center (212-639-1561), and Eli Lizza at Lenox Hill Hospital (212-772-3686). In Long Island: Brett Mellinger at Winthrop University Hospital (516-739-6300).

Multiple Sclerosis
Although there is no cure for Multiple Sclerosis, new treatment regimens offer substantial promise for those who have this disease of the nervous system. Symptoms come and go, and many with MS will experience no symptoms at all for years at a time. In the nineties the FDA approved three drugs, Avonex, Betaseron, and Copaxone, designed to reduce attacks and recurrences. "In the past, physicians took a wait-and-see approach toward treating the disease," says Arney Rosenblat of the National Multiple Sclerosis Society. "Now, with new medicines available, we have more proactive treatments." (Unfortunately, only 25 percent of the patients who could benefit from them are on the new medications.) The best MS specialists recognize that a combination of treatments is needed for most patients, including physical, occupational, and speech therapy. Also, frequent MS symptoms such as bladder, bowel, and sexual dysfunction, as well as depression, call for preventive measures from physicians. "This is a multidisciplinary disease and MS patients take a lot of time," says the National Multiple Sclerosis Society's Nancy Holland. "You need to find a doctor with a lot of MS experience." The top Manhattan neurologists specializing in multiple sclerosis are Brian Apatoff, director of the Multiple Sclerosis Center at New York Weill Cornell Center (212-746-4504); Frank Petito, also at New York Weill Cornell Center (212-746-2309); George Forster (212-410-6400) and Fred Lublin (212-241-7317) at Mt. Sinai; Joseph Herbert, director of the Multiple Sclerosis Center at New York University Medical School (212-598-6305); James R. Miller at Columbia Presbyterian Medical Center (212-305-5508); and Saud Sadiq at St. Luke's-Roosevelt Hospital Center (212-523-8070). In Queens: David Snyder, New York Hospital Medical Center (212-794-2281). In the Bronx: Rene Elkin (718-960-1335) and Charles Smith, both at Bronx-Lebanon Hospital (718-518-5581). In Brooklyn: Aaron Miller, Maimonides Medical Center (718-283-7470). In Staten Island: Allan Perel, director of the Multiple Sclerosis Center at Staten Island University Hospital (718-667-3800). In Nassau County: Marc Gordon, Long Island Jewish Medical Center (718-470-7366); Richard Blanck, North Shore University Hospital (516-466-4700); and Karen Blitz of the MS Care Center (516-674-7501). In Suffolk: Patricia Coyle, director of the Multiple Sclerosis Comprehensive Care Center (631-444-2599) and Lauren Krupp (631-444-1459), both at suny, Stony Brook. In New Jersey: Stuart Cook, St. Barnabas Medical Center in Livingston (973-972-5208); Gregory Anselmi, Bayonne Hospital (201-339-6531); and Mary Ann Picone, Gimbel MS Comprehensive Care Center (201-837-0727). In Connecticut: Stephen Waxman (203-785-5947) and Tim Vollmer (203-764-4280), both at Yale University Medical School. For the most up-to-date information about research developments, support groups, and education events, we suggest you contact the National Multiple Sclerosis Society at www.nmss.org or 1-800-FIGHT-MS.


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