Top Doctors’ Toughest Cases
Eight of this year’s top doctors reveal the most challenging cases of their careers.
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Giving a Teenager Hips of Titanium
Kayla Suttle went to Dr. Steven Zelicof with hips that were broken and arthritic.
Six years ago, 14-year-old Kayla Suttle hobbled into the office of Dr. Steven Zelicof, chief of orthopedics at Sound Shore Medical Center. Burdened with hips that were broken and arthritic, she was counting on Dr. Zelicof to help her walk again.
“Both Kayla’s hips were shot,” Dr. Zelicof says. Suttle, of Orange County, suffers from osteogenesis imperfecta, a hereditary disorder also known as brittle bone disease, marked by deficiencies in bone mineralization that renders its victims vulnerable to injuries and fractures. “Dr. Zelicof gave me hope that I could be a normal kid,” Suttle says. A double hip replacement was her only hope, but Dr. Zelicof braced himself for a host of complications.
“Her anatomy was completely off,” he says. Pins and screws—plus a loss of blood supply to the joint—had worn away and weakened the already fragile bone, leaving it wobbly and deformed. Trying desperately to avoid replacement surgery, her doctors had cut the soft hip bone and fused the growth plate in her right hip. “We had to reconstruct the whole area,” says Dr. Zelicof, who struggled to anticipate and address every challenge—including finding a prosthetic hip that would last more than 10 years. “We weren’t dealing with a ninety-year-old,” he says. In April 2004, over the course of two surgeries, he gingerly removed the damaged joint to implant a titanium ball and socket. But Dr. Zelicof’s role didn’t end after he peeled off the gloves.
“From a rehab standpoint, the endeavor was huge,” he says. “Her leg muscles hadn’t moved in years; all those neurons had to start firing again.” He monitored the rehab closely, with encouragement that touched Suttle deeply. “I pushed myself the hardest I ever had,” says Suttle. “I was so excited to walk—and so afraid, at the same time.” By her third weekend home from the rehab facility, Suttle was walking by herself. Today she is studying to be a nurse and carries herself so gracefully, her doctor says, “she could easily be a model.”
Finding a Brain…in The Pelvis
Dr. Jonathan Slater knew that his patient wasn’t psychotic but why was she behaving so bizarrely.
Sometimes, it takes an expert psychiatrist to know when a patient doesn’t belong in his office. Such
was the case last summer when
Dr. Jonathan Slater, of NewYork-Presbyterian Morgan Stanley Children’s Hospital, saw a 14-year-old girl, S.K., who had been discharged from a psychiatric hospital. “She was hallucinating, agitated, talking to herself,” says L.K., her mother.
S.K. was initially hospitalized after she’d had seizures in her New Jersey home. Upon discharge, her family stopped at a gas station. “She lunged out of the car and ran toward the highway,” her mother says. The psychiatric hospital ran a battery of tests, deeming her psychotic and plying her with anti-psychotic medications. “She was a zombie, slumped over and drooling,” says L.K., who took her daughter to Dr. Slater in June.
“She was acting up in his office, interrupting and storming about,” says L.K. Dr. Slater immediately diagnosed S.K. as having delirium, a neurological illness with a physical explanation. “It’s often confused with psychosis,” he says, “but a normal teen doesn’t develop schizophrenia in the course of a weekend. This was not a psychotic illness.”
To root out the underlying cause, Dr. Slater admitted S.K. to New York-Presbyterian, where she set off a debate between the psychiatry and neurology departments. “She’d be confused with us, lucid with the neurologists,” he says. S.K. went through further tests, including a spinal tap, an EEG, and an MRI. Finally, her excess weight and increased facial hair prompted her doctors to order a pelvic ultrasound to rule out an endocrine disorder. What the scan found was astonishing: a germ-cell tumor inside the ovary, in which a tiny brain was growing. (Such growths, called cystic teratomas, can also harbor primitive teeth and bones.) Absorbing this news, Dr. Slater suspected that S.K.’s body was producing antibodies to attack this new brain tissue—antibodies that also turned against her own brain, leading to a condition called autoimmune encephalitis. The tumor was removed immediately, and S.K. was placed on a regimen to disable and filter out the turncoat antibodies. Today, S.K. is recovering in a cognitive rehabilitation center in New Brunswick. “All this time, encephalitis was masquerading as a psychiatric illness,” Dr. Slater says. “It was an amazing case.”
Reviving a Blood-Starved Ovary
At 2 am, Dr. Monique Regard faced tough decisions regarding Elisabeth Hart’s dying ovary.
Elisabeth Hart’s summer vacation began with a sharp pain in her abdomen on the day after school let out for summer. The 12-year-old from Mount Kisco at first thought she had ruptured her appendix—but then radiology studies revealed an ovary in distress. “Her ovary was on the brink of dying,” says Dr. Monique Regard, a pediatric gynecologist at Maria Fareri Children’s Hospital at Westchester Medical Center. “It was black and blue, twisted into knots”—likely due to the plump cysts that resulted from an endocrine disorder, called polycystic ovarian syndrome, that Hart had. “The cysts acted like a ball on a bungee cord,” says Dr. Regard, choking off blood flow to the area and starving the ovary of nourishment. “It looked like a little purple eggplant,” recalls Elisabeth’s mother, Susan Hart.
With the ovary wilting away by the minute, Dr. Regard had to decide whether to remove it or try to untwist it—a wrenching replay of a dilemma she’d faced three weeks beforehand, when she failed to save the ovary of a nine-year-old. “At two am, we were sweating it out,” she says. “We didn’t want to risk that second surgery to take it out if we failed to save it.” Nor did she want to declare the ovary dead prematurely and play roulette with Elisabeth’s future fertility.
Working with surgeon Dr. Whitney McBride, she decided to press ahead with laparoscopic surgery to sew down the ovary, anchoring it to the ligament so that, once untwisted, it would be hard for it to twist again. “It was touch-and-go,” Dr. Regard says. “I was biting my fingernails that it wasn’t too late.” Susan recalls how the entire OR locked eyes on the video monitor for an hour, waiting for her daughter’s ovary to “pink up” with blood. When it bloomed with life, a cheer arose. “I was thrilled,” Dr. Regard says. A scan at four weeks confirmed the ovary was again thriving. Today, Elisabeth is a sophomore at Fox Lane High School with a scar that’s tinier than her pinky nail. Though she’s more concerned with tests and tennis than with starting a family, her mother knows that one day she’ll be relieved to have two intact ovaries. “I don’t know how many doctors would have gone the extra mile to let my daughter hold onto full fertility,” Hart says.
Making Tough Calls About a Rare Disease
Dr. Mark Burns weighs the risks of treating a patient against the risks of not treating her.
When the treatment for a potentially lethal disease is toxic, physicians can find themselves in a Catch-22. Dr. Mark Burns, a rheumatologist at Sound Shore Medical Center, stumbled into this dilemma last January when Karen Benitez (not her real name), a 24-year-old social worker, came to his office. When blood work flagged her as anemic, a doctor had ordered a CT scan that showed an inflammation of the aorta, the largest artery in the body, charged with carrying blood from the heart to sustain the body’s organs.
“It’s one thing if a minor blood vessel is inflamed,” Dr. Burns says, “but this is the aorta.” The implications of the condition, known as aortitis, were grave. Dr. Burns knew he had to start his patient’s treatment quickly to avoid permanent damage to the vessel, but he wasn’t sure where to begin. Benitez’s condition is an extremely rare, limited form of an already rare illness called Takayasu’s Arteritis.
For guidance, Dr. Burns reached out to his colleagues. He finally decided to prescribe steroids in high doses, along with methotrexate, a potent immunosuppressive agent, since the aortitis may result from her immune system wrongfully attacking its own tissue. It wasn’t an easy decision, and the fallout has left Dr. Burns in distress: the drugs have caused severe mood changes, weight gain, vomiting, and hair loss—but “the consequences of not treating her were even worse,” he says. “If the aorta grows dangerously inflamed, Karen may need an aortic stent graft”—a surgery typical among elderly patients with hardened arteries. “That’s a daunting prospect for a twenty-four-year-old.” As he weighs the implications, his patient’s challenge has become his own.