The Specialists

Traverse City’s reputation as a center for innovative health care continues to grow, thanks in large part to Munson Medical Center, which employs more than 400 physicians across 50 specialties. Procedures that were once cutting edge in the nation’s foremost medical centers are now routinely done here. The area is attracting, retaining and training doctors who are experts in their fields.

Some have grown up in the profession, such as radiologist Leah Carlson, whose grandfather started Traverse City’s first radiology practice. Others are recent recruits from downstate, like cardiothoracic surgeon Dr. Bobby Kong, whose dual background in mechanical engineering and medicine is providing him the expertise to perform the first robotic mitral valve repair at Munson.

The TCBN talked to a cross-section of area medical specialists about the latest procedures being performed here, how and why they chose their fields, and what one disease they would cure if they could.

Marc Krakow, M.D., Medical Dir., Advanced Wound Care

What is your area of expertise?

I’m board-certified in emergency medicine and hyperbaric wound care. I have a couple of partners with some experience, but I am the one full-time physician, the only one using hyperbaric treatment for wound care. I became interested in hyperbaric medicine in 1993 (when) I was a scuba diver. It is used in treating divers who ascend too rapidly without proper decompression (resulting in the condition commonly known as the bends).

How did you choose this field?

In 2007, I started to read a lot about hyperbaric treatment in all types of wound care. You no longer had to use one large chamber. Aside from decompression sickness, it’s used in carbon monoxide poisoning, cyanide poisoning, and radiation injury, like for cancer treatment complications. For example, in prostate cancer treatment, you radiate the colon, too, and will kill good cells in the colon.

Hyperbaric oxygen treatment is the only way to get more oxygen into cells. You can saturate cells with oxygen when under compression. It will revascularize, creating new pathways for blood vessels and healing. In the hyperbaric chamber with pressure, the body starts growing new tissues and blood vessels. Skin grafts can fail in a day or two. When you see them turning blue or black, hyperbaric treatment has been shown to keep them survivable. The same with a diabetic with a wound that is not healing, or a bone infection if antibiotics don’t work.

What will this specialty look like in 50 years?

Who knows how they’ll eventually try to get oxygen to tissue. Right now the best is oxygen and pressure. As long as we need to get oxygen delivered with precision (there may be ways to) open up blood flow so they don’t need hyperbaric treatment. Other possibilities are for blast-induced post-concussion syndrome, PTSD and cluster headaches. Being in hyperbaric treatment reduces migraines and may break the cycle. All these potential uses are being investigated.

If you could cure one disease, what would it be?

Traumatic spinal cord injuries. They are pretty devastating. They have a great impact on someone’s life on a long-term basis. They’ve experimented with hyperbaric treatment. We all hope there will be something to address them.

 

Yelena Kier, D.O., Hematologist/Oncologist

What is your area of expertise?

I’m currently practicing in the Cowell Family Cancer Center. I specialize in general oncology and am one of eight medical oncologists practicing in Traverse City. One of my partners, Dr. Lisa Hughes, and I are the only female oncologists practicing in Traverse City at this time. I treat patients with a wide range of diagnoses, including anemia, hematologic malignancies and malignancies of solid organs.

How did you choose this field?

I was drawn to hematology and oncology during my second year of medical school. I was initially very interested in the biology of oncology and oncologic pharmacology. When I started clinical rotations during my third year of medical school, I was able to meet oncology patients. Since that time, I have met countless patients and families, all of whom have inspired me with their caring, compassion and perseverance in the face of the ultimate adversity.

What will this specialty look like in 50 years?

We marked the 50th anniversary for the American Society of Clinical Oncology in 2014. In the past 50 years, we’ve discovered a cure for Hodgkin’s lymphoma, discovered vaccines used to prevent cervical cancer, been able to transform treatment for leukemia and developed powerful anti-nausea medications to alleviate one of the most troubling side effects of cancer treatment. I expect that the next 50 years will bring about more dramatic gains in the treatment of previously potentially untreatable cancers and more gains in curing the potential incurable malignancies.

What is the next big advancement in your area of medicine?

Currently, the pace of cancer research is rapid. Targeted therapies are being introduced and developed at a very fast pace. The current advancements in the world of oncology are focused on the development of a personalized approach to treatment. With the advancement of molecular and biologic testing, along with staggering expansion of immuno-oncology, the approach to chemotherapy recommendation is becoming more tailored to each patient. That, in turn, allows for better efficacy of therapy and longer and healthier lives for the patients.

If you could cure one disease, what would it be?

I would like to think that the cure for all cancer will be found in my lifetime. In reality, since cancer is a very heterogeneous disease, that reality may be several lifetimes away. I would like to see a cure for the cancers that are the main causes of morbidity and mortality for both men and women in this country such as lung cancer, colon cancer and breast cancer.

 

Bobby Kong, M.D., Cardiothoracic Surgeon

What is your area of expertise?

I’m an expert at adult cardiac surgery and have been in this field for 25 years. Besides coronary artery bypass operations, my other interest is in cardiac valve repair or replacement and aneurysm repair. I’ve been repairing mitral valves pathologies using a medical robot in which the chest incision can be smaller, more cosmetic and surgical pain can be reduced. The first robotic mitral valve repair has yet to be done at Munson as we are in the process of training the surgical team to this new approach. It is likely that I will be the only surgeon offering this service in northern Michigan.

Historically, I am also probably the first in the state to have started repairing aortic root aneurysm, preserving the native aortic valve (aortic valve spearing procedure).

In the past, aortic root aneurysm repair necessitated replacing a patient’s native aortic valve with an artificial valve (as the aortic valve resides inside the aortic root) until a surgeon in Toronto and one in the United Kingdom independently came up with new surgical techniques to repair the aneurysm and preserve the aortic valve.

How did you choose this field?

I chose cardiac surgery because I wanted to do something to help others. I also enjoy the technical challenges of delicate operations and enjoy using my hands to do good. Also having studied mechanical engineering in college, I also appreciate the beauty of the physiology of the heart.

What will this specialty look like in 50 years?

Fifty years is a long time for this relatively young surgical field since the advent of the heart lung machine in 1953 opened the door of cardiac surgery. Pathologies of the heart such as valvular diseases will be corrected via less invasive means; the result will also be better and more durable. Hopefully, artificial heart valves and the artificial heart will last for the life of the patient and without the need for anticoagulation or anti-rejection medications. This may be achieved by being able to “grow” a new heart or tissue using our own genes.

What is the next big advancement in your area of medicine?

We will have a vaccine to eliminate rheumatic fever worldwide, hence wipe out rheumatic heart disease, which damages heart valves.

If you could cure one disease, what would it be?

Through the development of gene therapy and medication, coronary artery disease – the number one killer in America – hopefully will be wiped out.

 

Brian Jaffe, M.D., Cardiac Electrophysiologist

What is your area of expertise?

I am a cardiac electrophysiologist. It is complementary to but totally different from the heart’s blood vessel system. It’s cardiology plus two years of electrophysiology.

How did you choose this field?

I was 23 years old and saw a revolution ahead. This was the area of cardiology we tried to understand with radio frequency ablation. We can change the way an abnormal current works in the heart. I could get in on the ground floor. I did a fellowship at Ohio State University after my training at U of M.

There were exciting discoveries being made. It was really, really fun. I wanted to be a big fish in a little pond. Traverse City had never had this. There was one guy in Petoskey doing some of the same stuff, but really nobody in much of the state So I started the program here. Today I have a new partner, Rob Kennedy, and two physician assistants. I probably see 15 to 20 new patients and 50 regular patients per week.

What will this specialty look like in the future?

Technology goes so fast. The technology will be hitting its stride. I think in 10 to 15 years we’ll need four docs.

What is the next big advancement in your area of medicine?

There are a number of advancements on the horizon. One thing that’s exciting for atrial fibrillation (AFib or irregular heartbeat) is better techniques for preventing strokes. There are new tools coming out. Drugs just don’t work really well (to treat and correct the rhythm), less than 50 percent of the time. Ablation therapy is better, but is still successful only 70 percent of the time. The longer you wait (to address the problem), the less successful it will probably be; if you are waiting six years, ablation is probably a bad choice. If it is done quicker, you may nip it in the bud. Although the technology is good (now), you hope for better.

The next advance is a better technique for preventing strokes. That’s the second problem of AFib, an increased risk of stroke. The standard approach is to put the patient on blood thinners, but the risk of bleeding goes up. The newest device with AFib is a device to stop the heart from forming clots.

If you could cure one disease, what would it be?

AFib is a huge problem. A massive number of people deal with a life-threatening rhythm. I’d love to see coronary heart disease stopped in its tracks.

 

Matt Madion, M.D., Ophthalmologist / Cataract Refractive Surgery

What is your area of expertise?

My specialty is cataract refractive surgery with LASIK and PRK (laser eye surgeries). We’ve now got a second Femto laser, a new piece of technology. It cuts, not burns. It only works in clear tissue like the cornea or lens. It was originally developed and marketed for LASIK to cut the corneal flap. It’s gone one step further, to section the cataract into pieces, then we remove it with ultrasound.

There are a couple of different methods (for cataract surgery). The majority is traditional blade through the eye to make the incision. What the laser does is provide another level of precision. It’s programmed to the micron. To watch them (lasers) work, it blows your mind how precise they are. For someone like me that’s been doing surgery for a long time, it’s exciting.

How did you choose this field?

It was the use of technology. At the time, 25 or 30 years ago, ophthalmology was always the one with the fancy gadgets. Also, you treat all ages. I did pediatrics. And it (ophthalmology) has a medical and surgical component. An internist does internal medicine all day. Surgeons just do surgery all day. In this role I get a little bit of both.

What will this specialty look like in 50 years?

By that point these things will be commonplace. When we replace somebody’s lens (for cataracts), the lens will be customized to that patient. They’ll have good reading and distance vision. We have special lenses, but nothing that’s perfect. In 50 years we’ll have a lens that will do everything.

What is the next big advancement in your area of medicine?

In the area of lens technology, there’s one that has been in use in Europe for a while. It corrects for presbyopia (farsightedness caused by loss of elasticity of the lens of the eye, occurring typically in middle and old age). It’s worked well. Technology is coming all the time. I’m expecting more of that in the next five to ten years.

If you could cure one disease, what would it be?

If we had a cure for the common causes of blindness that would be great.

 

Leah A. Carlson, M.D., Radiologist / Breast Imaging Specialist

What is your area of expertise?

I work as a general radiologist with specialty training in breast imaging, where I spend about two-thirds of my time. This includes evaluation of screening mammograms, work-up of screen detected abnormalities as well as clinical concerns, performing biopsies and interpreting breast MRI. Our group provides breast imaging services to patients in all the communities and hospitals serviced by Munson. We collaborate with local surgeons, medical oncologists, radiation oncologists, pathologists and genetics specialists in a weekly interdisciplinary conference where we discuss each individual patient’s newly diagnosed breast cancer to provide a collaborative and cohesive tailored treatment plan for each patient.

How did you choose this field?

My grandfather, Harry Weitz, started the radiology practice here in town (Grand Traverse Radiologists) back in the 1930s. My father, Charles Weitz, is also a radiologist and functions as the director of breast imaging for our group (Grand Traverse Radiologists). During medical school I was very interested in all areas of medicine and I liked how radiology allowed me to interact with all types of patients throughout all fields of medicine. As I went through my residency training I was drawn to breast imaging because I enjoyed the opportunity to interact more directly with patients, perform procedures, and to work closely with our colleagues in overlapping fields (surgery, oncology, pathology) to provide really great medical care for women.

What will this specialty look like in 50 years?

Radiology is constantly evolving and changing. In breast imaging in particular, we are currently seeing the adoption of 3D mammography, called tomosynthesis, which allows for improved cancer detection while simultaneously decreasing what we call “false positive” patient recalls for diagnostic imaging. We hope to have this technology in place at our Copper Ridge location by the end of March and throughout our hospital system within the next three years.

In the future, I think we will see some really exciting advancements in terms of functional imaging and finding ways to decrease radiation doses and improve efficiency and accuracy of radiation-free treatments such as MRI and ultrasound.

If you could cure one disease, what would it be?

The obvious answer, given the extent of my work in breast imaging, would be breast cancer. But I believe that given early detection via annual screening mammography, coupled with the currently available treatment options, which only continue to improve, breast cancer actually has a remarkable cure rate at present.

 

Patrick Gartland, M.D., Radiologist/Multiparametric MRI Specialist

What is your area of expertise?

I am a radiologist with Grand Traverse Radiologists, PC. Radiology involves diagnosing and treating disease and injury through the use of medical imaging techniques.

One new service we’re bringing to the area involves prostate cancer. We’re collaborating with the University of Michigan in prostate MRI. This is a new and quickly evolving technology, one that did not exist when I completed my residency and fellowship.

We wanted to make sure that we were supporting the urologists to provide the highest quality care for our prostate patients, so we established an agreement with U of M to guide us in setting up our prostate MRI program since they had an established program.

How did you choose this field?

I was drawn to radiology during medical school, recognizing how challenging the field was and that it is integral to the diagnosis and treatment of nearly every patient. Radiology crosses the spectrum from prenatal imaging through adulthood and requires collaboration with nearly every specialty in medicine. What is captivating to me is the challenge of the puzzle of diagnosing diseases, understanding the pathology of disease, and how it manifests on imaging. The patient interaction was also appealing.

What will this specialty look like in 50 years?

Radiology technology will continue to evolve, improving our abilities to diagnose and treat different diseases. It is hard to predict where radiology will be in 50 years, but I’m confident that it will look vastly different from where we stand now and will remain integral to the health care industry.

What is the next big advancement in your area of medicine?

One of the most exciting current advances is with prostate MRI. The 3-Tesla (3T) MRI and refined scanning parameters have allowed us to visualize tumors in the prostate that we could not previously detect on imaging. This is quickly changing the standard of care for the diagnosis and treatment of prostate cancer and offers promise for further advances.

Interventional Oncology is also evolving. Interventional radiologists are now able to treat select patients by directly targeting tumors and burn or freeze them with probes, deliver doses of radiation beads directly to the tumor, and/or block the blood supply feeding tumors.

If you could cure one disease, what would it be?

Cancer. I think the title of the book “The Emperor of All Maladies” summarizes it best. It is a terrible disease that can be brutal on patients and all of their loved ones.

 

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