Dr. George Pazos’ medical background runs the gamut from treating military jet-fighter pilots, to serving as backup for NASA missions, to treating kids and adults in his Hudson Valley practice.
Pazos specializes in otolaryngology, the medical field involving conditions of the head, neck, ears, nose, and throat. A University of Pennsylvania graduate, he received his medical degree from the Uniformed Services University of the Health Sciences. He served as a resident at Walter Reed National Military Medical Center, became a Navy flight surgeon, offering medical care for Navy F-18 fighter and Marine helicopter pilots, and was trained by NASA for medical support during space shuttle programs.
He also served as chief resident of otolaryngology at Bethesda Naval Hospital and the Walter Reed Army Medical Center, and has received awards for military medical care, including treating personnel wounded in the second Gulf War. In addition to his practice at ENT and Allergy Associates in Yorktown and Carmel — a medical group with offices throughout New York and New Jersey — Pazos is clinical assistant professor of medicine at Mount Sinai School of Medicine.
“Otolaryngology is a very rewarding, dynamic field, with several innovative new approaches to the way we do things,” he says.
Among those state-of-the art techniques is a method known as an oral brush biopsy, which helps detect cancer in the mouth. “Prior to about 2010, you would have to do a knife biopsy if a patient had an unusual feature in their oral cavity. Now we can do a biopsy with the Oral CDx brush. There’s no surgery needed, it’s painless, and within just a few days, we get a very detailed report as to whether any cancer cells are present.”
Pazos says the process uses a state-of-the-art computerized technique. “A microscope automatically scans and picks out areas of interest in the cells, whittling down from thousands of images to about 20, that it presents to a pathologist” to analyze. “What’s interesting is that this technology is the same type used in the military Star Wars program, where some degree of sophisticated artificial intelligence was needed.”
Another high-tech method, known as balloon sinuplasty, can help unclog blocked nasal passages. “It’s the same approach as when a balloon is used in cardiology to dilate blood vessels. Here, everything is done through the nasal cavity, so there’s no incision; it’s much less painful and recovery is dramatically improved,” Pazos says.
Still another leading-edge procedure helps in nasal polyposis cases. “We inject the polyps with steroids. In some cases, I’d inject on say, a Monday, and by the next week when we do a follow-up, in the majority of patients, the polyps would either be completely gone or reduced by about 80 percent. Relief can last for six months or so.”
Simpler screening for cancer of the esophagus and other throat conditions is another aid to otolaryngology physicians, Pazos says. “This test can be done easily, with a very thin scope inserted through the nose, into the esophagus.” It’s useful in a condition commonly known as silent reflux, where stomach acid can pool in parts of the throat. Silent reflux is sometimes linked to a possibility of cancer of the esophagus, “so testing is very helpful.”
Pazos sometimes encounters life-threatening problems in his practice. “About three or four times a year, patients will arrive with severe airway distress, where they probably wouldn’t have made it through the night without a procedure to open the airway right away. It’s very rewarding to help in cases like that,” he says.
About thirty percent of his practice involves pediatric patients, ranging from kids with sinus infections to youngsters with sleep apnea. Surprisingly, the potentially dangerous breathing condition of sleep apnea — often associated with overweight, middle-aged men — is a problem for some children, too, Pazos says.
“There’s been shown to be a significant correlation between children with attention deficit disorder and sleep apnea,” he says. “If it’s not addressed early, the condition can have long-term effects, so sleep apnea should be considered if a young patient has attention deficit disorder and they snore — snoring is the warning sign of sleep apnea. The epidemic of pediatric obesity in the United States also plays a part; we’re seeing more and more children with breathing troubles,” he says.
When Pazos, who lives in Pleasantville, isn’t practicing medicine, he can often be found playing soccer, coaching his three kids’ sports teams, enjoying historical fiction and nonfiction, and traveling.
Nearly 26 million children and adults nationwide have diabetes, according to the American Diabetes Association; and another 79 million with prediabetes are teetering on the edge.
“The prevalence of Type 2 diabetes, in particular, is increasing in the total population,” says Dr. Rachel Colvin, a nephrologist — kidney specialist — who serves as director for dialysis at Orange Regional Medical Center in Middletown. “The key with diabetes is prevention and nipping it in the bud. Aggressive blood-sugar control is of the utmost importance,” says Colvin, who is also a partner in the nephrology department of the Orange County-based Horizon Family Medical Group. “Controlling blood pressure is important, too. It can’t prevent diabetes, but it can help slow the progression,” she says.
Educated at Tulane University, she originally majored in economics. “But then I had an injury that required several surgeries, and people in the medical field who helped me so much were an inspiration. That’s how I first got interested in medicine. People ask why I went into nephrology; I tell them ‘Because it’s a way I can help others.’ ”
She received a doctorate in medicine at New York College of Osteopathic Medicine and completed her medical residency at North Shore University Hospital. Colvin went on to serve as assistant chief resident at Memorial Sloan-Kettering Cancer Center in Manhattan; she then returned to North Shore with a fellowship in nephrology.
She notes that even though many people are being diagnosed with diabetes early, and awareness of its sometimes severe complications is increasing. “I still end up seeing some patients far too late. Diabetes is similar to high blood pressure in terms of it progressing silently. If you let diabetes go for five or 10 years, you’ll sometimes see diabetic complications that are irreversible.”
Colvin, who’s been practicing in the Hudson Valley for 11 years, works with all types of kidney diseases, including dialysis patients. “Almost 50 percent of new dialysis patients are diabetic,” she notes, and cautions that diabetes is not the only cause — though it is one of the most common — of renal (kidney) diseases. She treats kidney transplant patients, too, as well as offering preventative and nonsurgical treatment of kidney stones through dietary modification and medication. In addition, Colvin treats renal problems linked to infections and physical injury.
Nowadays, she says, patients on dialysis — those who require having their blood cleansed by passing it through a special machine because the kidneys aren’t functioning sufficiently — have more options than in the past. “There’s even a home unit available, so patients don’t have to go to a dialysis center,” she says. “But you have to be highly motivated; you need to be able to use the machine and to do the treatment daily.” Dialysis can be temporary in some cases, she notes. “Some patients do go off dialysis if it’s being done for an acute case. But in chronic cases, patients generally require ongoing dialysis.”
She also refers some patients for kidney transplant surgery. “These transplants really change lives. We’ve had cases of wives, husbands, best friends, siblings, donating a kidney to a loved one. One man received one from his sister; later he got another one from his wife. Some donors are even just good Samaritans who responded to a newspaper article about someone they didn’t even know who was seeking a kidney. I’ve had patients receive kidneys that way.”
Colvin points out one especially positive aspect of her medical field: “If a patient’s kidneys fail, there’s almost always an alternative. I can use dialysis machines that can save a person’s life. There aren’t a lot of other organs where a machine can substitute like that. It can be a real lifesaver.”
The world of cardiac care is constantly changing as new technologies continue to evolve. Cardiac electrophysiology, which deals with the study and treatments involving the heart’s electrical activity, is no exception.
“This is a young field — only about 20 years old — and it’s expanding by leaps and bounds,” says Dr. Sankar N. Varanasi of the Hudson Valley Heart Center in Poughkeepsie, who specializes in clinical cardiac electrophysiology.
“Among the emerging technologies is remote navigation system, which we utilize in cardiac treatment. It uses a magnetic field to help navigate a tiny catheter that has electrodes mounted on the tip. This gives you an opportunity to navigate through portions of the heart you couldn’t reach during standard surgery. It’s less traumatic, and more precise,” says Varanasi. The technology is often used, he explains, in procedures that treat abnormal heart rhythms. “It increases our ability to perform the procedure more safely.”
Varanasi, who grew up in India, went to Osmania Medical College there, and completed his internship at Mount Vernon Hospital when he came to the U.S. He did his internal medicine residency at Yale University’s Norwalk Hospital, and had fellowships at General Hospital Center at Passaic, New Jersey, Norwalk Hospital, and the University of Wisconsin.
“My father died of cardiac arrest in India, back in 1971,” says Varanasi. “He couldn’t afford medical care, and he would say that no patient should ever feel they can’t go to a doctor because they can’t afford it. In those days, even if he’d been in the U.S., the cardiac treatments weren’t nearly as good as they are now. But his situation was enough for me to want to go into medicine — to want to change that.”
A wide range of services fall under the umbrella of cardiac electrophysiology. “It involves cardiac pacemakers, automatic implantable cardiac defibrillators, ablations, and various other heart-monitoring devices and procedures.”
The newest type of high-tech pacemakers, Varanasi explains, are helping some patients with congestive heart failure by resynchronizing the heartbeat with more precision than ever before. “At one time, the only option for these patients might be a heart transplant; they would just die suddenly. This treatment has given back many patients’ quality of life, taken them off a heart-transplant list, and offers them lifesaving protection.”
Varanasi, who lives in the Poughkeepsie area with his family, adds that regardless of which treatment a heart patient receives, it can make a huge difference in their life. “Several patients have come back and told me, ‘I never realized how good I could feel, thanks to this procedure.’
“One 84-year-old patient had loved to travel but said he couldn’t anymore because of his health. He underwent a cardiac procedure, and now he’s traveling again; he sends me postcards saying how much the procedure has changed his life and how much he’s enjoying everything again. He’s doing more enjoyable things in life now then just spending time in doctors’ offices.”
“People sometimes ask how I can do this kind of work every day. They say, ‘Isn’t it depressing?’ ” But for breast cancer surgeon Dr. Zoe A. Weinstein, helping others is a key motivation. “You feel like you’re on a path toward managing the problem, striving to put new tools in your arsenal, and dealing with the disease together with your patients — as a team.”
Weinstein received her medical degree from the Albert Einstein College of Medicine and did her residency at Montefiore Medical Center, and says a real-life experience encouraged her to enter the oncology field. “When I was a young woman, a close family friend was dying of advanced breast cancer; her youngest child was only six at the time,” Weinstein recalls. “I was in my year of pathology residency and had done basic research on breast tumors. I’ve always been interested in it intellectually — that, and women’s health. I love the combination of being a surgeon and taking care of women.”
Weinstein, medical director of the Fern Feldman Anolick Center for Breast Health at Benedictine Hospital in Kingston — part of the HealthAlliance system — is enthusiastic about advances in breast cancer treatment. She notes that, as a physician, “You keep your mind open to new developments, but it’s important to also have a cautious eye and wait until the data comes out. You don’t want to find out in five years that you’ve jumped on a bandwagon for a certain treatment that’s not in a patient’s best interest.”
Among the leading-edge approaches: “We’re seeing, in breast cancer treatment, a movement away from the idea of, in many cases, immediately doing radical surgical treatment — of radical mastectomy, where the breast and underlying muscles are surgically removed, which was extremely disfiguring. Now, there’s more focus on limited breast surgery, of lumpectomy,” in which just the tumor and a relatively small amount of surrounding tissue is taken out, followed by additional treatment. This combination can render radical surgery unnecessary.
Also, Weinstein notes, “Twenty years ago, most people had all their lymph nodes removed during cancer surgery. Nowadays, in cases where patients appear to have little or no breast cancer involvement in the lymph nodes, surgeons tend to remove fewer lymph nodes than they might have in the past.” This can help reduce chances of side effects such as limited range of motion in the arm or shoulder, and lymphedema — painful arm swelling. “And if the patient goes on to have all the additional treatment they would need, like chemotherapy and radiation, they seem to do as well as patients who have all their lymph nodes removed,” Weinstein says.
New high-tech diagnostics also help doctors customize treatment plans. “There’s a test now, the Oncotype DX test, which can be done on certain breast tumors that are known as estrogen-receptor positive,” Weinstein says. “The test looks at 21 genes within a woman’s tumor sample and evaluates the patient’s risk of breast cancer recurrence if they were only to get anti-estrogen treatment such as tamoxifen. Thus, we can sometimes avoid having to give these patients chemotherapy. We’re now better able to tailor a patient’s treatment to the biological behavior of the tumor. It’s very encouraging.”
Weinstein recalls one patient with advanced cancer who underwent a double mastectomy and intensive chemotherapy. “She had a daughter in high school and a son who was 12 at the time.” Seven years later, the patient is so far doing fine, Weinstein says. “She’s been able to see her daughter go to college, and her son grow up. Those years together are crucial for the development of a family; it’s been very meaningful for me, too.”
Weinstein says the debate continues among some health professionals over how extensively to use breast cancer screening tools such as mammography. “While mammography is a great screening tool, it’s not designed to pick up everything,” she says. In cases where a woman has dense breasts, for instance, other screening techniques such as ultrasound can be an additional valuable tool.
“The leading cause of cancer-related death overall for women in the U.S. is lung cancer, but the number one cause of death for middle-aged women between 45 and 55 is breast cancer. So it’s very important to get screened,” Weinstein says.
Recent research also supports the apparent value of exercise in breast cancer prevention for many women, she says. “There’s also a relationship between postmenopausal obesity and cancer risk in general. So it’s empowering for women to know they can do something about factors such as the amount they exercise and how much they weigh, to help lower their breast cancer risk.”
Weinstein, a mom and resident of Rhinebeck, is an advocate for helping patients get all the support they need throughout their cancer journey. “When patients are finished with treatment, they should be told what to expect next,” she says. “It’s not enough to just say, as a doctor, ‘See you in six months after your next mammogram.’ ” Factors like good nutrition, exercise, and other preventative steps should be emphasized, she says. “And also, what else to expect after cancer treatment — sometimes there can be sexual dysfunction, mood swings, an altered sense of yourself.”
The American College of Surgeons has made a positive move in this direction, she says — it now mandates that all patients in its affiliated hospitals have a survivorship plan, and Benedictine Hospital is part of that post-treatment program. “Each cancer patient receives a handout that says, ‘You got this much chemotherapy, this much radiation; this plan is for you to follow’ — there’s a whole psycho-social component. I think that’s going to make a difference.”
“Neurology is such a diverse field; it encompasses everything from migraines to pinched nerves to strokes, seizures, Alzheimer’s and Parkinson’s disease, to nerve and muscle conditions,” says Dr. David Ober of Rockland Neurological Associates in West Nyack.
“One of the best things about being a neurologist is that it’s never boring,” he adds. “So many areas of the brain and nervous system are involved, and every patient presents differently. It keeps you on your toes, keeps you thinking.”
Ober graduated from Albany Medical College, did his internship at Albany Medical Center, and completed his residency in neurology at Mount Sinai Medical Center, followed by a fellowship in neurophysiology at Saint Elizabeth’s Medical Center at Tufts University in Boston.
“No one else in my family has a medical background,” he says. “But when I was in medical school, I was fortunate to find a role model who inspired me during my training — Dr. Ramani, a neurologist who now practices in Westchester. He got me excited about the field; that’s how I became so interested in neurology.”
One of Ober’s special interests is electrodiagnostic studies. “This involves diagnosing and treating people who have problems with their peripheral nerves — carpal tunnel syndrome, or pinched nerves in the neck or back,” says Ober, who lives with his family in New City. “When most people experience this sort of pain, they usually go to a primary care physician or an orthopedist; they get shuttled around to different doctors. But if the situation is a pinched nerve, for instance, someone with specialized training like a neurologist is worth seeing initially.”
Another area of his expertise is neuromuscular disease and conditions, as well as administration of Botox. “Most people think that Botox is just for cosmetic uses. But in my world, it’s not. It’s a neurological drug that affects neuromuscular transmissions, helping muscles to relax and become more flexible.”
He adds: “When your brain tells your muscle to move, a nerve has to secrete a chemical that goes from the nerve to the muscle — it puts this whole chain reaction into effect, then gets the muscle fibers to contract. So if you can inject Botox into a targeted muscle, you can actually stop production of that chemical going to the muscle, and it will selectively weaken it. If a patient has a muscle that’s twitching or spasming, or a condition that causes painful tight spastic muscles, injecting Botox into those muscles can significantly improve the condition.”
In October 2010, the FDA also approved Botox injections to treat chronic migraines in adults. “That’s really caught on,” says Ober. “It can make a big difference for migraine sufferers.” Botox can also benefit patients with certain bladder disorders; it’s also approved for treating spastic limbs in stroke patients, he notes.
“I recall one female patient with multiple sclerosis who had a lesion on her spinal cord that activated the nerves; one of her shoulders wouldn’t stop twitching. But once you managed to isolate which muscle was responsible and injected Botox into the muscle, the problem stopped within three days. It was pretty dramatic.”
“That’s the amazing thing about Botox,” Ober says. “Before it was available, there weren’t really any good treatments for some patients. There’s no doubt this medication has changed people’s lives.”
Dr. Richard P. MacDermott, who specializes in treating Crohn’s disease and ulcerative colitis, is enthusiastic about the latest treatments for these often-painful digestive conditions. “A lot of advances are going on in the field,” says MacDermott, director of the Inflammatory Bowel Diseases Center at Albany Medical Center.
Crohn’s disease triggers inflammation in various areas of the digestive tract lining and can involve affected tissue; it sometimes causes abdominal pain, severe diarrhea, even malnutrition. Ulcerative colitis can be equally debilitating; it usually occurs only in certain parts of the colon and has some similar symptoms. Both conditions (among others) fall under the umbrella term of inflammatory bowel disease, or IBD.
“I’ve always wanted to be in medicine, since I was young. And taking care of patients with these diseases, seeing how devastating they can be, is what got me interested in the field,” says MacDermott, who is also a professor of medicine at Albany Medical College. MacDermott earned his medical degree at Ohio State University and did residencies at Brigham and Women’s Hospital in Boston; with fellowships at Boston University and the Dana-Farber Cancer Institute. In January 2012, he was honored with the Lifetime Achievement Award from the Crohn’s and Colitis Foundation of America for his many contributions to the field, including research, teaching, and publishing. He and his family live in Latham.
“People with severe symptoms of Crohn’s and ulcerative colitis often fear leaving the house because of the symptoms. So it’s encouraging that there has been tremendous progress in the past 20 years — both in finding out what causes it, and in new medications.”
The latest breakthroughs include use of new biologics like Remicade, Cimzia, and Humira, he says. (Biologics are derived from living cells — similar to the way some vaccines are made — and are aimed at the immune system.) “Usually given by intravenous infusion or self-injection for these diseases, they’re very helpful for some patients.”
Surgery is also a key part of many treatment plans for Crohn’s, MacDermott says. “This often requires removal of part of the intestine. If you have severe disease, and there’s a complication like a stricture — a narrowing — or a perforation or abscess in the intestine, surgery can likely get rid of that. Then you can more effectively use a biologic afterward.”
Current treatments are now directed at specific parts of the immune system, he says. “That’s why many of these biologic agents are also used in rheumatoid arthritis, psoriasis, and other chronic inflammatory diseases — the immune system is functioning abnormally and causing damage to the joints or the skin.”
Both Crohn’s disease and ulcerative colitis are most often diagnosed during the teen or young adult years, says MacDermott. “But now we’re seeing more cases in children under age 10 — even by age five,” he says. “In general, Crohn’s disease and colitis are rapidly increasing, in terms of the number of patients at all ages around the world.”
Their exact cause is still unknown. “Genetics and the immune system both play a role,” says MacDermott. “It’s thought that diet is sometimes also a factor regarding the symptoms.”
Studies investigating the causes of Crohn’s and colitis have expanded over the past 10 to 15 years, MacDermott says. “The research is exciting. For instance, by sequencing the genes of patients (analyzing the genes’ “chemical alphabet”), about 150 areas on chromosomes involved with Crohn’s disease have been discovered, and about 50 areas involved with ulcerative colitis. It’s been determined that the genetic sequencing in Crohn’s or colitis patients is different from the sequence of people without the conditions,” he explains.
“Other ongoing studies in the U.S. and Europe are also now sequencing intestinal bacteria — there are maybe 15 or 20 thousand types of bacteria, with many subtypes. So I think that, when all this information is put together in the future, specific bacteria types will be shown to be involved with genetics and the immune system in initiating the disease. Then hopefully more targeted treatments can be developed for Crohn’s and colitis.”
Castle Connolly Medical Ltd. is a healthcare research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America’s top doctors and top hospitals. Castle Connolly’s established survey and research process, under the direction of an MD, involves tens of thousands of top doctors and the medical leadership of leading hospitals.
Castle Connolly Medical Ltd., expanded its nominations process in late June 2011, and now invites ALL licensed physicians to participate in the nomination process to help Castle Connolly to identify regionally and nationally outstanding top doctors. The nominations process can be accessed, online-only, at www.castleconnolly.com/nominations. The company’s physician-led team of researchers follows a rigorous screening process of nominated physicians to select top doctors on both the national and regional levels. Careful screening of doctors’ educational and professional experience is essential before final selection is made among those physicians most highly regarded by their peers.
The result — we identify the top doctors in America (click here for the full list) — and provide you, the consumer, with detailed information about their education, training and special expertise in our paperback guides, national and regional magazine “Top Doctors” features and online directories.
Physicians selected for inclusion in this magazine’s “Top Doctors” feature may also appear as Regional Top Doctors online at www.castleconnolly.com, or in one of Castle Connolly’s Top Doctors guides, such as America’s Top Doctors® or America’s Top Doctors® for Cancer.
Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.