Photos by Joe Treleven
Top Doctors Twin Cities 2015
See the 19th edition of our full Top Doctors list, including nearly 750 doctors in 42 specialties.
Dr. Mahmoud Nagib
ADVANCING THROUGH TECHNOLOGY
Mahmoud Nagib was born in Rome, Italy. He has lived in Italy, Sweden, Holland, Germany, Portugal, France, and Egypt (his father was in the foreign service). He earned his medical degree from the University of Cairo. His medical background includes a neurology fellowship at the University of Oslo, Norway, and a neurosurgery residency at the University of Minnesota. He is now president of Neurosurgical Associates Ltd.; clinical assistant professor at the University of Minnesota Medical School; staff neurosurgeon at Abbott Northwestern Hospital, Children’s Hospital and Clinics of Minnesota, and Fairview University Hospital; and associate neurosurgeon at Hennepin County Medical Center. His specialty is neurological surgery, which covers both the brain and spine. He is board-certified in adult and pediatric neurological surgery.
What were the key research areas in neurosurgery when you were a young doctor?
There were three main ones. Vascular neurosurgery (aneurysms) was a major part of the practice, seizure surgery also was a big area, and then you had tumor surgery—there were new chemotherapy agents and more extensive treatment of brain tumors.
What have been the biggest changes in neurosurgery since you began practicing?
The operating microscope was introduced in the late 1970s. There was ideal visualization and magnification during surgery. Visualization using the operating microscope was like night and day. It was greatly improved. We could do surgery that we could not do before.
The second change is the impact of the CT scan. It was also developed during the 1970s. Everybody takes it for granted now, but it was like a revolution for the early diagnosis of brain disease.
Then there was the introduction of the MRI, which was developed in the 1980s; it was complementary to the CT scan and enabled more early diagnosis of problems and more specific, targeted treatment.
In the 1990s and 2000s, you had the introduction of the intraoperative MRI, which means you can do MRIs during a procedure. If you’re dealing with a tumor, you can identify if the whole tumor has been removed and address complications as soon as possible. At Abbott Northwestern (where the intraoperative MRI is housed), they have a well-developed monitoring system. During surgery, especially spine surgery, you can monitor the function of the nerves in the spinal cord and identify early deficits before they become a problem.
It’s also important to talk about neonatal neurosurgery. Thirty years ago, when a baby was born at 24 weeks, it was impossible to imagine the baby would survive. We have an outstanding neonatal unit at Children’s. Now it’s very common to have babies born at 24 weeks and survive. A large number will need brain surgery because of hemorrhaging in the brain, but they survive and thrive. The management of lung and vital signs like blood pressure has also changed. I would attribute that to my neonatology and perinatology colleagues. Their skills are outstanding.
What research or projects excite you now?
Years ago, if you had a malignant tumor, management was biopsy and radiation. Now it has evolved to include aggressive surgery, focused radiation, and targeted chemotherapy.
With the management of aneurysms, now you have the availability of endovascular procedures—using coiling instead of open surgery to fix the aneurysm.
Now we have also developed different instrumentation to stabilize the spine during surgery. When you do surgery on the spine, sometimes you have to take a significant amount of bone and end up with deformed bone. Now it is much more elegant. You can take less bone because you have more visualization, too.
What would you like to see accomplished in the next 20 years?
I would like to know that we have a treatment for brain cancer. You handle a brain tumor with surgery, chemotherapy, and radiation.
I think we’re going to be able to identify some form of vaccine to cure brain tumors.
What about pediatric developments?
We have been involved in in utero surgery for babies with spine deformities like spina bifida. I would like to see a program for in utero neurosurgery in Minnesota. The answer is money. We need money to develop the program. Right now, it is still in the investigative stage, and it’s not without risks. There is an almost 30 percent chance that in utero surgery can induce an abortion. We offer the pros and cons; the final decision is the mother’s. If she wants the surgery, she has to go to San Francisco or Philadelphia. Most of the mothers prefer to carry to term. Right now, we wait [to do surgery] until the birth. At times the baby is delivered a little early, and then we offer surgery within the first 48 hours of life.
Dr. Ann E. Van Heest
CHANGING YOUNG LIVES
Ann E. Van Heest grew up in Robbinsdale and was a competitive rower for the U.S. national team. That sports background sparked her interest in orthopedics. Van Heest, who attended the University of Minnesota Medical School, went on to become board-certified in orthopedic surgery and hand surgery, with a specialty in pediatric hand surgery. She is a hand surgeon at Gillette Children’s Specialty Healthcare and the University of Minnesota Masonic Children’s Hospital. She is also on staff at Shriners Hospitals for Children, and she is a professor in the Department of Orthopaedic Surgery at her alma mater.
This morning, you performed surgery on a child born with six fingers webbed together. What did you do?
The two most common issues are children born with extra digits or webbing. Today, I took out the extra digits. I reconstructed it so the baby has five fingers with normal webbing. The baby is 7 months old. Normally you do it between 6 months and 12 months of age. At that age, the baby’s hand is a little bigger, the risks from anesthesia are less, and the baby is still dependent on the parents. “Congenital hand differences” is the current nomenclature. We’re trying to get away from using terms like “malformations” and “deformities.”
Is it particularly satisfying because you are working with children?
Children born with these congenital hand differences don’t go out and do it to themselves (as you might find in athletes). They are so resourceful.
Kids are great to work with. They’re really fun. They have good attitudes, most of them. They heal well.
How has your practice changed over time?
We’re seeing larger babies. The average size of babies is about 10 pounds. During the birth process, the baby’s shoulder can get stuck. When we deliver a large baby, the nerves off the neck (known as the brachial plexus) can be injured. Then they can’t move their hands. It’s like a paralysis in the hands, or it can affect whole arms.
We started a brachial plexus clinic at Gillette’s about 16 years ago. When we started, there was only one other one in Texas. There have also been good advances in surgical techniques. We now do nerve transfers—we take a nerve from a place that is working and put it into the place where the brachial plexus is.
Kids also may get shoulder dislocations. Now we use ultrasound and can treat it at 6 to 12 months of age. Before, we didn’t know about it until the child was 2 to 5 years old.
What research or projects excite you?
We developed the Minnesota Hand Function Test app for iPhones. It’s something therapists and doctors can use if you are assessing kids for hand function. It’s for kids of different ages. In the past, we had tests for writing, typing, manipulating objects. Nowadays kids do touchscreen. This is a timed test; they have to drop and drag, match shapes, touch dots. It measures how effectively you use your hands.
How do you work to evolve treatment strategies in your field?
There is a congenital hand anomaly study group, and we meet every three years. I just got back from our meeting in Holland. We talk about cultural differences for different groups. People have gotten a lot more into psychological aspects of hand differences. We’re trying to get kids more mainstream and help them to become psychologically adjusted. We have better surgical techniques. We continue to modify techniques to have best function possible. We talk about how important it is for children to have care at specialty centers.
What would you like to see accomplished in your field in the next 20 years?
I would like to see more areas or centers of expertise to provide specialty services for kids in the United States. The idea is more developed in other countries—Canada, United Kingdom, Holland. I’d also like to continue to better understand the difficulties kids have. We have nice prosthetics and we’ve started some 3D printing in prosthetics. What we really need now is prosthetics that allow sensation.
Dr. Mitchell G. Kaye
IMPROVING DETECTION AND PREVENTION
Mitchell G. Kaye always wanted to be a doctor. Medicine appealed to him for the intellectual challenge and complex problem solving. A graduate of the University of Minnesota Medical School, Kaye is president of the Minnesota Lung Center/Minnesota Sleep Institute. He is board-certified in internal medicine and pulmonary disease. He is an adjunct associate professor of medicine at his alma mater.
What have been the biggest innovations in pulmonary medicine and sleep medicine?
Many years ago, we didn’t have that many drugs to treat asthma and COPD. We’ve seen a tremendous growth in the number of medications, their effectiveness, and patient tolerance. There has never been good treatment for pulmonary fibrosis. Last October, the FDA approved two new drugs for it. Our patients are now starting to take them. It’s exciting to see. Lung cancer is the leading killer among cancer deaths. There hasn’t been a good way to screen for it. There was a very large trial that involved more than 53,000 people. Some got a low-dose CT scan. Some got a chest x-ray. The CT scan was more sensitive in identifying early cancers, so there was a 20 percent reduction in lung cancer mortality in the CT scan group. The U.S. Preventive Services Task Force recommended annual screening for lung cancer in adults aged 55 to 80 years old who have a 30-pack-per-year smoking history and currently smoke or have quit within the past 15 years.
For many years, we’ve had bronchoscopy, but in some situations there might be an abnormality that we can’t get to with the scope. Often we have to go to the operating room. Now we have instruments that allow us to get to the edge of the lung, access spaces in the lung, to get biopsies. It has been fantastic.
With sleep medicine, testing in the lab was a good tool but not always the easiest diagnostic tool. We’ve seen an increase in sleep apnea home testing. If the results are abnormal, we may do additional testing. It’s opened up the ability to identify sleep problems in a group of people who may not need to come to the lab.
We’ve seen greater options for masks for CPAP machines (which blow pressure into the throat so it doesn’t close when you sleep). The sophistication of those machines leads to increased patient comfort, higher compliance. Modems on the CPAP machine allow us to track the amount of time a person wears it. The modems allow us to measure adherence, and our staff is able to intervene.
What would you like to see in the next 20 years?
In the mid-1970s, the EPA banned material with asbestos. There is a 30- to 40-year lag between exposure to asbestos and development of asbestos-related lung disease. The incidence has dropped significantly because of the ban. As we’ve seen a decline from 22 to 14 percent in cigarette smoking in Minnesota, I’m hoping to see decline in smoking-related lung disease.
I also think there is a future in wearable technology, smartphone apps. It’s already popular among fitness enthusiasts. I would not be surprised to see an improved wearable technology that will allow physicians to track what patients do at home. I wouldn’t be surprised if wearable technology changes the landscape of how you monitor your health.
Dr. Kiran K. Belani
Pediatric Infectious Disease
Kiran K. Belani says it’s not uncommon to have a set career path in her home country, India. For Belani, that path was medicine (there are 10 doctors in her family). She entered St. John’s Medical College in Bangalore at 16. Her specialty is pediatric infectious disease. She is board-certified in pediatrics and pediatric infectious disease and has a diploma in travel/tropical medicine and hygiene. She is on staff at Children’s Hospitals and Clinics of Minnesota.
In 1985, you began caring for the first child in Minnesota to be diagnosed with HIV. You cared for her and other children like her. What was that experience like?
In the early days, children would get hospitalized frequently. It was very hard on the nurses—after doing so much, the children would still die. We didn’t have the drugs. After 1996, we had more drugs. Now we have 30-some drugs, and now it’s almost boring: You see the patients in clinic, you check with their life issues, not disease issues. It’s a total 180-degree turnaround. I wish more diseases would go from life-threatening to a chronic, stable course.
What has been the biggest change in pediatric infectious disease?
The last 30 years in America, we would see so many meningitis cases each week—six or seven in a month. Then they started developing vaccines. It’s two to three cases per year now. In the past, we’d have to tell parents their children would have brain or neurological deficits. We don’t have to say that as often anymore.
In infectious disease, we tend to see more refugees than other fields. We see people from South Asia, Burma (Myanmar), Africa. We see most often tuberculosis, parasitic disease like malaria or gastrointestinal parasites.
Parents are happy they can get help for their children. In their countries, TB can be a death sentence. Coming from another country, I’m sensitive to cultural issues. We have to get to know each community’s different sensitivities. We have interpreters, social workers. It’s not isolating anymore to take care of someone from another country. It’s a daily routine.
What are your thoughts on vaccinations?
Vaccinations are the greatest thing that happened in the last 70 years. These diseases are not simple diseases. They can cause harm and last the lifetime of the child. The problem is that people aren’t seeing the diseases around them. But they are just a plane ride away. There’s measles, whooping cough, diphtheria in other countries. When you don’t see a bad thing, you don’t think about it. You get complacent. I try to give patients the facts. I give them the data. Look at it then, look at it now.
What are the lessons of Ebola?
We need a little more planning ahead—I think this is happening. We have so many treatments and resources, but we don’t have medical literacy—understanding how Ebola is spread. When there is panic and fear, there is not enough communication about the pathology to the people suffering. The more complicated medicine gets, the more time we have to spend educating families and parents.
What ongoing research or projects in your field excite you today?
We are seeing more new drugs for tuberculosis. The drugs in HIV are a tremendous help. I have a picture of a patient with a dinner plate full of the 25 medications she took for HIV. Now patients like her come to the office for a single pill with three drugs in them. It’s very exciting.
Genetics is very exciting—where you tailor the medicine to the patient’s specific genetic needs. Suppose you have a problem with one medication. In the future, we’ll be able to tell we can’t use it. It’s customizing.
What innovations are on the horizon?
Getting to know the body’s natural flora is very trendy right now. There is research into bacteria living in us and their role. How are they helping us? How are they not helping us? That understanding will help chronic disease.
What would you like to see accomplished in the next 20 years?
Health for the rest of the world. I travel to India a lot. There are still tons and tons of people who don’t have vaccinations, antibiotics. They die of simple things. Gaps between advances here and gaps in other countries like India are big, but it is improving.
Dr. Michael R. Wexler
Allergy and Immunology
MANAGING ALLERGIC RESPONSE
Michael R. Wexler is the son of a doctor and the father of a doctor. He is a board-certified allergist/immunologist and pediatrician specializing in allergies, asthma, and immunology. A graduate of the University of Minnesota Medical School, Wexler practices at Advancements in Allergy and Asthma Care Ltd. He is also on staff at several local hospitals and is an associate clinical professor at his alma mater. In September 2014, his practice began offering the FARM (Food Allergy Risk Management) program.
What troubles you about how food allergies are traditionally managed?
The normal course is to identify what someone is allergic to, then avoid it. If the kids happen to eat [what they’re allergic to], you treat it with emergency medicines. It’s very unsatisfactory for parents and physicians to be told, “Just do your best to avoid the food.” There’s no in-between.
How can we prevent this?
There’s been a lot of discussion over the years about trying to desensitize children. They were seeing results a couple of decades ago when they were doing allergy shots with food. Then there was a mistake, tragically, and the child died.
That was the last big approach before switching gears and introducing the food orally. Dr. Richard Wasserman has been a real pioneer.
How does FARM work?
Rather than just give medicine to treat the symptoms, we’re trying to train the body to tolerate it. The very first dose is 2.05 micrograms of peanut. One peanut weighs 250 milligrams. We have only been doing peanuts.
While we do the buildup phase, the kids eat the food twice a day within a window of time and they can’t exercise for a certain time before and after eating. If they’re sick, we have to back down a bit. If things go smoothly, the kids will get their maintenance dose in four to six months. Some parents are happy if the kids can eat foods with trace amounts [of peanuts] safely. Some parents want their kids to be bite-safe. The current recommendation is that they eat the food daily, indefinitely.
Have there been any side effects?
It’s rare, but sometimes the kids have allergic reactions and they need epinephrine. Typically it occurs when they’re exercising or sick. The most common concern is developing eosinophilic esophagitis, an allergic condition of acid reflux. We watch for it.
Has the FARM approach been tested independently?
Dr. Wasserman and I are clinicians. We know the kids and can see what is happening. I understand the way of medicine is very controlled studies, but the approach has been so slow and cumbersome. Dr. Wasserman has desensitized about 300 kids and adults. He hasn’t had anyone who developed eosinophilic esophagitis. As long as we’re careful and know when to back off, it seems to be safe for the vast majority of people.
Dr. Donna Block
EXPLORING APPROACHES TO CARE
Donna Block knew in sixth grade that she wanted to become a doctor, but life took her down a different road. She graduated college with degrees in speech pathology and audiology. She married and had two daughters. Years later, at age 32, she came back to medicine and enrolled at the University of Minnesota Medical School. She later received her MBA from the University of St. Thomas. In 2004, she founded Clinic Sofia with a goal of providing women the tools to stay healthy and to nurture a community of competent and healthy women. She is board-certified in obstetrics and gynecology.
When you started practicing, what were the key research areas in Ob-Gyn?
In 1991, we were talking about the viral implications to cancer. It’s evolved to where we are more sophisticated at testing, identifying the types of HPVs that are the culprits, and are now vaccinating young women and men. Also, we used to use many more invasive things such as amniocentesis, laparoscopy. We’ve moved to more minimally invasive approaches— genetic testing, identifying potential problems. Medicine, as much as we can, is trying to be preventive.
Are people getting the prevention message?
I think people are getting the message. We’ve been giving it. There is plenty of information in the media. It’s one thing to know it. It’s another thing to implement it.
I think more and more people are looking at the holistic approach—dealing with the mind-body connection and dealing with the role stress plays in overall health. In the ’60s and ’70s, people were doing Transcendental Meditation. Now people are doing things that are mindful. People are becoming more in tune with the mind-body connection. I believe medical schools are addressing it more, too.
What has been the biggest change in Ob-Gyn research since you became a doctor?
The genetics—identifying a different way of looking at the fetal chromosomes. Now we draw the mother’s blood, then separate mother’s and baby’s DNA. Then we look for more problems. We can anticipate a lot more. It helps us take better care of them, but it also helps them to make plans for whatever decisions they make.
What is exciting in your field that we don’t know about yet?
The role that genetics plays in our overall health. That’s going to be the new frontier. Take cancer—if they can identify a person’s genes or the genetics associated with the cancer, they can develop a treatment to knock it out.
What would you like to see accomplished in your field in the next 20 years?
I would like to see the ability to have more of the personal, caring touch with your patient—to have the relationship and to be able to have the time to do so. You have the same amount of time (in a day), but you can figure out how to be more efficient.