5 Top Docs Talk Medicine and More

Best Pediatricians in the Bay Area

     Your child has just been diagnosed with asthma, and you’re seeking a specialist who can help keep her symptoms under control. Or maybe you’ve just changed health plans and aren’t sure who to select as your new pediatrician. That’s where the research of Avvo, a Seattle-based company that rates dental, legal and medical professionals, can help guide your decisions.
     Avvo rates all doctors on a 10-point scale, using a proprietary algorithm that factors in peer endorsements as well as experience, education, training, research, publishing and awards. These ratings are regularly refreshed based on new information gleaned from doctors as well as from certifying, licensing and disciplinary boards.
     The pediatricians profiled here were selected from a list of 184 local pediatricians who represent the top 5 percent of practitioners in their field according to their Avvo rating. Consider this guide a starting point in helping your families choose a local physician who can best meet your family’s medical needs.
     For more about Avvo, visit www.avvo.com.

Matthew Lodewick, M.D.

Pediatric Allergy
Allergy and Asthma Medical Group of the Bay Area, Berkeley and San Ramon

     Growing up on the East Coast, Lodewick, 42, always wanted to attend college at the University of California, Berkeley. As a student at Cal, he began studying comparative literature and molecular and cell biology, before deciding to pursue a career in medicine. His inspiration came after tutoring third- through fifth-graders in West Oakland, where high asthma rates among children have been problematic for years. Knowing that he wanted to help children breathe easier, he went on to study medicine at the University of Alabama at Birmingham and completed a pediatric residency at Seattle Children’s Hospital and the University of Washington. Lodewick remained with the University of Washington to complete a fellowship in both adult and pediatric allergy/immunology and was clinical instructor of allergy/immunology at the Seattle Children’s Hospital and worked in private practice. He returned to the Bay Area in 2004 and lives with his wife and 7½-year-old son in the East Bay.

We seem to be hearing a lot more about children with allergies, particularly peanut allergies and gluten sensitivity. Are you seeing more kids with allergies or food sensitivities?
     There is no question that there is a higher prevalence of true food allergies, and a child’s reaction to a food allergy such as peanuts can be serious and sometimes life-threatening.  Twenty years ago, you may have seen a couple cases of peanut allergies in a school; now it is not uncommon to see several cases in a single classroom.

Are you also seeing more cases of asthma in children?
     Asthma is tricky. Through the late ’90s, we were seeing a fair rise in the amount of asthma in the community; now there seems to be still a slight amount of increase in asthma since 2000 but to a much lesser degree. For a while, we were also seeing an increase in severe attacks and asthma deaths, but fortunately, we have seen a leveling of these severe attacks. Asthma is a condition for which we have treatment approaches that control the majority of asthmatics, yet the extent of troubling asthma attacks remains much too high.

What are some of the advances in medical technology that have helped you in your area of practice?
     Spirometry is a test that allows us a better measure of a person’s lung functions. Commonly a stethoscope will not detect underlying changes and so following up with spirometry as part of the overall assessment provides an objective tool in guiding care.
     ImmunoCAP tests complement skin testing in assessing allergic sensitizations. They still have limitations, but they add some predictive value in assessing the likelihood of sensitizations, particularly for food.
 

Andrew Wen, M.D.

Pediatric Pulmonology
Kaiser Permanente Oakland Medical Center

     A first-generation American, Wen, 48, grew up hearing stories about his grandfather, a country physician who served his community during the turbulent years between the fall of Imperial China and the rise of Chinese Communism. Wen’s parents immigrated to the United States after escaping the Communist Revolution in China, and he was born and raised in the Bay Area. He attended medical school at the University of California, Los Angeles School of Medicine and completed his residency at Children’s Hospital & Research Center Oakland. He later completed a fellowship at Children’s Hospital Los Angeles and serves as an associate professor of pediatrics at the University of California, San Francisco. Wen lives in the East Bay with his wife and four children, ages 8 to 16.

When did you decide to become a doctor, and how did you choose your specialty area?
     I always knew that I wanted a job where I could help people but had originally considered majoring in journalism or teaching. One summer I volunteered to work as a candy striper at Kaiser Permanente Santa Clara Medical Center. I remember playing checkers with kids who were hospitalized and how good it felt to make them smile and distract them from their illness. In college, I took some pre-med classes and found that I did well and really enjoyed them. Medicine also gives me the chance to explore new topics as I would as a journalist and to educate students and patients as I would if I had become a teacher. Pediatric pulmonology was an easy choice. I had enjoyed pulmonary physiology since college and enjoyed working with children.

What do you like best about your job?
     I enjoy making a difference in the lives of my patients, helping to give them hope and keep them healthy. For some of my pediatric patients with rare conditions, it’s like running a marathon that never ends, and it’s easy for them to get discouraged. I work to help them feel better so they can enjoy just being a kid. It’s also exciting to work as part of Kaiser Permanente’s Northern California Cystic Fibrosis and Teaching Center. We’re the only accredited, non-university center in the country that works with both children and adults with CF [a chronic, progressive and frequently fatal genetic disease primarily affecting the respiratory, digestive and reproductive tract], and our center’s outcomes rank in the top 10 percent of approximately 120 cystic fibrosis care centers throughout the country.

How has the field of pediatric pulmonology changed over the years?
     The life expectancy of babies born with cystic fibrosis has almost doubled over the last two decades. We can now screen for cystic fibrosis in newborns, allowing us to diagnose the disease and begin treatment faster, rather than waiting until a child presents symptoms. There are many medications available now that can be used to help cystic fibrosis patients stay healthy and lead productive lives. We’ve also seen a lot of advances with childhood asthma. There was a time when kids with asthma were hospitalized frequently and discouraged to engage in regular play or sports. Thanks to new medications and aggressive treatments, kids today are better able to manage their asthma symptoms and flare-ups and to lead healthy active lives. I have asthma myself, although I went undiagnosed as a child. I think having a chronic pulmonary condition helps me to better understand what my patients are going through and to give them optimism.

Howard Rosenfeld, M.D.

Pediatric Cardiologist
Pediatric Cardiology Medical Group and Children’s Hospital & Research Center Oakland

     As a pediatric cardiologist, Rosenfeld, 51, treats children who are born with congenital heart problems, as well as those who develop conditions because of infections, abnormal heart rhythms, trauma or inflammation. He is an expert in the use of ultrasound for non-invasive imaging of the heart for children of all ages and provides information to cardiac surgeons at Children’s Hospital Oakland through intra-operative ultrasound imaging of the heart. A graduate of Harvard University Medical School, Rosenfeld also directs the cardiac fetal program at Children’s Hospital Oakland where prenatal diagnoses and treatment are provided. He served his residency in pediatrics at Boston Children’s Hospital, and also completed a fellowship in pediatric cardiology there. Rosenfeld lives in San Francisco with his wife and is the father of two daughters, ages 18 and 15.

You offer fetal cardiac services at Children’s Hospital Oakland — what does that entail?
     When I was starting my career in the early 1980s, fetal echocardiography, a test that uses sound waves (ultrasound) to evaluate a baby’s heart, was a new concept. Today they are a major part of fetal cardiac centers and offer us the ability to detect, evaluate and manage fetal defects prior to a baby’s birth. Early fetal cardiovascular imaging allows us to diagnose heart defects as early as 12 weeks gestation and to follow the mother and baby’s care until delivery. After the baby is born, we can immediately start to address the infant’s cardiac defect through corrective surgery. Half of the children requiring surgical repair of a heart problem are now able to undergo surgery before their first birthday.

How has the field of pediatric cardiology changed since you first became a doctor?
     Cardiac magnetic resonance imaging didn’t even exist when I was in training, and it’s now become a very useful tool that has come into more widespread use for pediatric patients in the last decade. With new MRI techniques providing high-quality images of anatomy and function, it is possible to measure the actual flow of blood, giving us a non-invasive method of evaluating patients with congenital heart defects. Various childhood heart diseases that previously required extensive surgical procedures are now treated with cardiac catheterizations or minimally invasive surgical procedures, which have also led to much better patient outcomes.

What do you find most rewarding about your job?
     I enjoy working closely with families on an ongoing basis. I have patients who I first began working with as infants and are now turning 18. Many of these patients were born with complex cardiac issues and are now leading productive and rewarding lives.
 

Mina (Myngoc) Nguyen, M.D.

Pediatric Allergy
Chief of Allergy, Kaiser Permanente Oakland Medical Center

     Born in Saigon, Nguyen, 57, first became interested in medicine while volunteering in orphanages and nursing homes. After graduating from high school, she moved to the United States and attended medical school at UCSF where she also completed her residency. After a fellowship at the Children’s National Medical Center in Washington, D.C., Nguyen returned to California and has practiced medicine at Kaiser Permanente’s Oakland Medical Center for 26 years. She lives in Oakland and is the mother of three children, ages 21, 23 and 26.

What kinds of medical conditions do you treat in your practice?
     I treat patients with allergies, rhinitis, food, drug allergies and immunodeficiency. We have seen an increase in childhood asthma over the years, and a large percentage of children with asthma also have allergies. I see children with nasal and food allergies, dermatitis and eczema. We are also seeing more cases of eosinophilic gastroenteritis, a gastrointestinal disease that affects both children and adults, and more cases of allergies. The allergic reactions we see can be hay fever, hives and cases of eczema.

How has your field changed over the years?
      We’ve seen a lot of advances in asthma medications over the past decade, and these are helping patients to better prevent and control their symptoms. We now have combination medications that contain both an inhaled long-acting bronchodilator and an inhaled corticosteroid. This means that two areas of asthma can be effectively treated at the same time: the bronchodilator works by widening the airways, making it easier for patients to breathe, and the inhaled steroid reduces and prevents inflammation of the airways.

What do you find most rewarding about your job?
      I find it very rewarding to take care of my patients and to help them make changes in their lives that can lead to better outcomes. I’ve had patients who have come in suffering from shortness of breath, and after getting their asthma under control, they are able to lead active lives.

Matthew Gracianette, M.D.

Pediatrics
Kaiser Permanente Hayward Medical Center

     A native of New Orleans, Gracianette knew at the age of 15 that he wanted to pursue a career in medicine. He attended medical school at the University of Washington School of Medicine in Seattle and completed his internship and residency at UCSF Medical Center. A musician, avid hiker and bicyclist who often rides to work, Gracianette, 47, lives in the East Bay with his wife and rescue dog.

How did you decide at such an early age to pursue a career in medicine?
     When I was still in high school, I volunteered at a local hospital, and one of the patients I worked with had spinal meningitis and was seeking company. It was a transformative experience for me. Later, when I moved to Seattle to attend medical school, I volunteered at an inner-city day care and it solidified my decision to not only pursue a career as a physician, but to also work in pediatrics.

What’s a typical day in your job?
     I work as a hospitalist at Kaiser Permanente’s Hayward Medical Center, so I do rounds with patients on the pediatric ward, consult with emergency physicians on children who are brought into the emergency department and am also called in on high-risk deliveries for mothers who are having a C-section, or for babies who are showing signs of distress. In the hospital, I see children with asthma, seizure disorders, kidney infections and fractures. I also spend time calling families who have recently been discharged to find out how their child is doing, see if they have any questions, and to ensure they had a positive experience while their child was in our care.

How has your field changed over the years? Is there any particular technology that has changed how you do your job?
      Kaiser Permanente implemented electronic medical records in 2008, and it has changed the way we provide care. Gone are the days when we had to request a patient’s paper file and wait several hours to have it delivered. We don’t have to rely on asking a patient’s family for their child’s medical history or what medications they are taking. I can now access a patient’s complete medical history, including past surgeries, medications and office visits, and have that information when I first walk in to introduce myself to a patient and their family. If we need a child for an X-ray, we get the results electronically within a matter of minutes. We also have physician orders that can be accessed electronically, and provide guidelines for many common pediatric conditions. If, for example, a pediatric patient presents in the emergency department with asthma, the emergency physician can quickly determine the appropriate medication and dosage for the child’s age and weight, as well as find hyperlinks to the most current best practice guidelines.