Our Success Stories
Second Opinion Help
H.S. was a 69-year-old, generally healthy man who developed a mass in his abdomen. His internist sent him to the local University hospital to see a general hemato-oncologist (blood cancer specialist) who diagnosed him with B-cell lymphoma (blood cancer) and sent him to initiate standard chemotherapy. The mass was growing rapidly, impeding his ability to eat, so time was of the essence. I first recommended that all serious diagnoses required a second opinion, ideally from a specialist in this condition. In this case, John Hopkins had a lymphoma unit that was conveniently located within driving distance. I was able to secure an appointment with a leading specialist in lymphoma research the very next day. That same day, I reviewed all the patient's test results, researched his specific condition, and discovered two major issues: the diagnosis had been established on insufficient grounds, and no molecular subtyping had been performed. When we went in to see the Hopkins specialist the next day, he agreed on both counts and ordered a tissue biopsy of the mass. I succeeded in obtaining an appointment for the biopsy in the next few days. After the procedure, I was able to reach the assigned pathologist and impress the urgency on her. The biopsy was processed and the beginning steps of chemotherapy were arranged on the very same day. Although the biopsy confirmed the diagnosis, the patient's subtype was a much more aggressive type than usual, requiring a more aggressive treatment regimen The chemotherapy finally commenced only four days later and now, 5 years later, the patient is in remission.
Patient-Centered Care
About a year ago, my very healthy mother-in-law called me out of the blue and in a panic said "I'm not feeling well.” after feeling her very irregular pulse, I quickly called an ambulance. I rode with her in the ambulance to the local Hospital to ensure I was allowed to be by her side as soon as we arrived. In the ambulance, the EKG showed a very erratic rhythm; however, on arrival, the EKG already began to show a sinus rhythm (normal). A heart attack needed to be ruled out, so they completed a series of tests, and she was admitted to the hospital for observation. By morning, her shriveled figure in a hospital bed belied her impeccable physical health and mental competency. Although a heart attack was ruled out, the physician in charge wanted her to stay for further testing, to be seen by a cardiologist and an endocrinologist, prolonging her hospital stay. I was adamant that this was the wrong way to go! A hospital stay can be absolutely necessary, but when avoidable it comes at considerable risks for a very elderly person. Physical inactivity is a risk for loss of strength, blood clots, and multiple infections including pneumonia. Additionally, medical tests to make sure nothing was missed can endanger the elders’ health. I contacted her cardiologist and booked an appointment for the very next day. An endocrinologist was scheduled in a few weeks. Upon questioning, the attending admitted that with such follow up she could really go home today. Reviewing the discharge papers I was focused on the one abnormal EKG from the ambulance, but it was nowhere to be found and nobody was missing it. I walked back to the ER, presented the issue, and the nurse returned with the EKG strip! The next day, at the cardiologist's office, the physician was very pleased - "You can't imagine how often I have no idea what happened in the ER! Now I'm able to have a clear understanding of the situation, and adjust your medications according to the tracing." My mother-in-law returned to raking and tending her beautiful garden.
Advocacy For Patients
S.M. was a client, who was diagnosed with early-stage breast cancer. A mastectomy was determined to be the best course of action, so she went to see a surgeon who immediately assumed that she wanted a reconstruction. When she voiced her doubt, the male surgeon exclaimed, "But you will never feel whole again!" A mutual friend encouraged her to contact me. When we spoke, she was confused and distraught. "Do I have to?" she asked me. "No, you certainly don't have to!" I replied. "You can decide whether you want to or not -- it's entirely up to you!" Empowered, she chose to consult a plastic surgeon to explore her options. He described various options for reconstruction, making it all sound routine and simple. By the end of the appointment, she was leaning toward one option. But later on, we had lengthy discussions, where I pointed out the various risks associated with each procedure. Reconstruction surgery more than doubled the surgery time. Longer surgery time is associated with increased risks such as ventilation-induced pneumonia and others. I asked her, "Are you sure you really want to have more injury done to your body than absolutely necessary? Leading to more pain and a much-prolonged recovery time? And again, increasing the risk of postoperative complications?“ Knowing how much she cared for her young son, I asked: “You want to return as a functional mom to your child as soon as possible? Isn't that your highest priority?" She thought about it, read about the women's movement called "going flat," women opting to accept the body as it was after surgery instead of opting for additional surgery, and decided to not pursue reconstruction. Now, over a year later, she is very happy with her choice, as the quick recovery allowed her to commence and complete chemotherapy very soon after surgery Her decision to start chemotherapy was also difficult, as it was not evident that she would actually benefit from it. I got her an appointment with the best breast oncologist at Johns Hopkins, accompanied her, and discussed the pros and cons with her. Although the doctor did not have enough data to recommend her one way or another, she decided to go ahead. This doctor closely monitored her response and modified the protocol as needed. With G-d's help, she has been disease-free since.
Industry Connections
W.O. was a 69 y old lovely gentleman, a retired IT professional. He also had cerebral palsy. Recently he developed a chronic lung disease that was worsening. After frustration with pulmonologists, they turned to me for guidance. I searched to find a local pulmonologist, Dr. T. who specialized in his condition and arranged an appointment. Three days before the appointment, he was taken to a local emergency room because of difficulty breathing. When we saw him, he was distressed but stable and needed the specialists urgently! The next day, we tried to convince the attending that he needed to see this specialist as soon as possible. "When we discharge him he can go there, but he needed too much oxygen to be discharged," they said. " So can he be transferred?" we asked. "I don't see any medical need for that," the hospital doctor insisted. "But he needs to see the specialist! As soon as possible!" I argued. "He can see his specialist after he is discharged," they told us. But he could not be discharged! After I spoke to the charge nurse and every possible doctor, the attending finally relented: "Okay fine, I don't mind if you find a way to get him there. But I'm not initiating it." So the following day, I started calling the office of the specialist at the University of Maryland in Baltimore. I started at 8:30 AM, and by 4 pm Dr. T. returned my call. The multiple assistants and schedulers I had spoken to must have explained the situation to him, as he went straight to the point and gave, me succinct instructions on how to proceed: "Make sure the patient is not discharged -- he needs to be an ICU inpatient for this to work. Have the attending call the Medical Transport service at this number, and tell them that I'm the accepting physician. Make sure all records are collected, and start the process as soon as possible." Quickly, with the help of the charge nurse, all was put into action. While waiting, I called the receiving ICU and spoke to his future nurse to give her a heads-up about the patient’s condition. His cerebral palsy and speech impediment easily led medical personnel to mistake him for a very low-functioning person; combined with his humility, this put him at great risk of neglect in the hospital environment. By 11:00 pm, the patient was strapped to a stretcher for his trip to the University of Maryland ICU. I waited around to make sure that no last-minute glitch could undo my day's efforts, and it wasn’t until my patient had left in the ambulance that I finally went home. Over the next two weeks, I remained intimately involved, as every day brought a new set of surprises, such as when his medications were changed and he went into atrial fibrillation. Soon after, cardiology became involved, and they ordered a cardiac angiogram ("cardiac catheterization") which is a high-risk procedure to evaluate coronary artery perfusion. I waited all day to speak with the cardiology department to challenge this order while the patient was put on "nil by mouth," meaning no nutrition. I succeeded in raising the issue with the pulmonologist, who agreed. I believe he spoke to the cardiologist, and the procedure was canceled. After all the tests were completed, Dr. T sat down with us to outline the little that could be done to improve the patient's functioning. The new goal was to return to rehabilitation to stop the deconditioning. Since the fall risk kept the patient in bed, every day in the hospital meant no walking, losing strength and function, and being in an environment at high risk for infection. Social work had to be contacted and a good rehabilitation center needed to be found before the weekend. Late Friday afternoon, he was transferred to the Hebrew Home Of Greater Washington.