Medical Miracles

Five stories of the amazing work our Top Docs do every day.

Medical Miracle No. 1

Dr. Ryan Katz
Curtis National Hand Center, Union Memorial Hospital

Dr. Ryan KatzMost Baltimoreans can recall the fury of Hurricane Irene in August of 2011, but Christopher Green has a memento from the storm others can’t claim: a toe growing out of his hand.

It all unfolded as the storm knocked out power to his home near Chestertown, and water started pouring in an atrium window. Grabbing an articulating aluminum ladder, the off-duty police officer and father of two braved the darkness to try to make a temporary fix. But he fell, and as he did so, his left thumb got caught in the ladder, ripping the digit from the bone and taking nerves and tendons with it.

“Sitting in the dark, I could feel pain in my forearm and felt blood on my leg,” says Green, 42,  “but I didn’t realize my thumb was torn from my hand until I heard my stepdaughter scream.” The thumb was wedged in the ladder’s mechanism, and it would take a fireman’s crowbar to remove it.

A fire truck carried him and his thumb—on ice—through flooded roads to Chester River Hospital Center, which tried to stabilize the injury, but they had no expertise in reconstruction of the digit. The hospital staff told him, “You need to get to the Curtis National Hand Center at MedStar Union Memorial.”

So a sergeant drove him to Baltimore, where the Hand Center’s Dr. Ryan Katz tried desperately in the ER to save his thumb. He reattached it and graphed veins to vascularize the digit. But the way the thumb had been torn, not cut, from the hand made things more difficult, and it came down to saving the patient or the digit. Three days later, the thumb was removed, and the process to reconstruct the hand began.

Doctors surgically attached the patient’s hand to his upper thigh for three weeks to cover the wound with healthy tissue without detaching and reattaching blood vessels. Then, in February, surgeons removed the patient’s big left toe and moved it to where the thumb had been, a six- to eight-hour process that relied on the microsurgical skills of Katz and the chief of the Curtis National Hand Center, Dr. James Higgins. Over the ensuing weeks, additional surgeries would improve the motion, dexterity, and appearance of the reconstructed toe-turned-thumb.

“We’ve done similar reconstructions before,” says Katz, 37, “but I think the mechanism we chose [using the toe] is unusual—and the timing with the hurricane was interesting.”
“Our aim is to achieve form and function, so during the transplant surgery we had to trim down the new thumb and transfer nerves to restore function.”

In the future, Katz may perform an additional surgery to add movement to the tip of the new thumb, to help with a few tasks that are still a bit challenging.

“Picking up coins, paper clips, or pills is still a little tricky,” says Green. “I can do it, but it takes extra effort.” The important milestone, however, is that Green returned to his police department duties in September.

“Just because of the length of time, they did make me requalify,” he says. “But I can fire a weapon, cuff a prisoner, or simply tie a shoe.”


Medical Miracle No. 2

Dr. Oliver D. Schein & Dr. Judith Goldstein
Johns Hopkins’s Wilmer Eye Institute

Retired entrepreneur and Jiffy Lube founder Willis James Hindman, 78, always enjoyed raising thoroughbred race horses on his Westminster farm. “There is nothing more beautiful than seeing a horse in motion and at full speed,” he says. “It’s something very special to me.” But the key to that special pleasure, of course, is being able to see the horse.

And when severe age-related macular degeneration (AMD) destroyed Hindman’s vision to the point where he couldn’t read or recognize faces of family and friends, let alone watch his horses, depression set in—not uncommon with AMD. He wasn’t alone in his affliction: About two million Americans have various forms of macular degeneration, which affects the region of the retina responsible for central, detailed vision.

But Hindman is now a member of a very exclusive AMD club, since the surgical implantation at Johns Hopkins’s Wilmer Eye Institute of a tiny, new Implantable Miniature Telescope (IMT) in his left eye.

A surgical procedure uses the IMT to replace the eye’s natural lens—as with cataract surgery— implanting it behind the iris, the colored, muscular ring around the pupil.
Hindman is one of three patients at Wilmer (the first two were in the trial) to benefit from the telescope, which costs about $15,000, not including the price of surgery and rehabilitation.

After implantation last December, Hindman participated in a rehabilitation program at Wilmer’s Low Vision Rehabilitative Service that trains patients to effectively use the bionic eye, which takes six months to a year. “The disease robs people of central vision in both eyes,” says Wilmer ophthalmology professor Dr. Oliver D. Schein. “They can navigate around a room with peripheral vision, but when they open the fridge door, they can’t tell the milk from the orange juice. So if you put the device in the right eye, there’s enough magnification [over two times] to see what’s in the fridge.” Schein, who performed the surgery, has a greater understanding of the technology than most: He led Wilmer’s participation in a four-year, multi-center FDA study that provided data on the effectiveness of the IMT with end-stage AMD.

“This is still relatively new, and is being done at centers that had experience with the original trial, and where there’s good cooperation between the surgeon and a low-vision group,” says Schein. “Having one without the other just doesn’t work—it’s a real team effort.”

“After surgery, the therapy is the most critical component,” says Dr. Judith Goldstein, an optometrist, Hopkins assistant professor, and chief of Wilmer’s low-vision rehab center, which is also responsible for early screening of patients to see if the IMT will be effective in their cases. “The telescope eye sees things centrally and the non-telescope eye basically sees things peripherally. It’s unlike anything they’ve ever experienced.”

Hindman says the change in his life has been dramatic.

“The services I have been provided have been inspiring. They make me want to get up in the morning. I have started becoming more interested in working with my horses because I can see. I can also now read, watch TV, and, yes, seriously, I replayed golf for the first time, and honestly the ball looked like a grapefruit, two-and-a-half times its normal size.”

Which the PGA might consider an unfair handicap.


Medical Miracle No. 3

Dr. Kuldeep Singh
Saint Agnes Hospital

Students and staff at Howard County’s Reservoir High School know Carole Ferrante as a phys-ed teacher and volleyball coach with boundless energy and an upbeat outlook. But 18 months ago, life was very different for the 44-year-old. At 307 pounds, she was tormented by nearly constant feelings of humiliation that were fueling depression and even suicidal thoughts.

“I felt like a fraud going to work every day as a gym teacher,” she recalls. She dieted and followed a supervised exercise program to lose weight, but her thyroid disease made the task almost impossible. “Something had to change,” she says. “I didn’t want to wake up any more. I remember one day I wanted to drive my car under a truck.”
It was a crowning moment of utter humiliation that led her to drastic measures.

“I love amusement parks, but one day I tried to ride a roller coaster, and the harness wouldn’t lock over my stomach,” Ferrante says. “So the guy announces over the loudspeaker, ‘Lady, you are too fat, you have to get off this ride.’” What could be worse? That she was on a field trip with her students.

Seeing her dire psychological state, her endocrinologist urged her to go the route of bariatric surgery, and recommended Dr. Kuldeep Singh at Saint Agnes Hospital. In May 2012, after months of research and preparation, Ferrante went ahead with the surgery. And after a couple hours of surgery, and six weeks of recuperation, Ferrante discovered a new world.

“People who choose bariatric surgery usually try everything out there first, like diets and exercise,” says Singh. “But the weight always comes back, and you start to believe that anything you do will fail, until something really hits you, an emotional trigger,” such as a medical scare caused or aggravated by obesity, including diabetes, cardiovascular problems, or orthopedic issues. “Of course, it’s critical to realize that surgery is just a tool, and you’ll still need to permanently change your lifestyle,” he says. “Otherwise, whatever diet, behavior, and environment caused the problem will make the weight come back. The followup is for life.”

Singh should know: He’s been performing bariatric surgery for 12 years and now does about 350 procedures a year. But as obesity becomes an epidemic in the U.S., he knows he’s only scratching the surface. “We have only taken care of 1.5 percent of eligible people who would benefit greatly from surgery,” he says.

In addition to surgery in May 2012, Ferrante took advantage of the hospital’s bariatric support network, including a procedure to remove excess skin.

Her journey to a new life also included a return to an amusement park. And this time—and an entire wardrobe later—the fit, 157-pound Ferrante enjoyed a totally new experience.

Says Ferrante, “I rode every single ride in that park, just because I could!”

Online Video Exclusive: Visit with Carole Ferrante


Medical Miracle No. 4

Dr. Stephen Contag
Sinai Hospital

Few mothers would ever imagine that their own blood could be toxic to their unborn babies, but it can happen—as it did to Stephanie Buckley, who is among the 6 percent of the population that has Rh-negative blood. And in its most severe form, that incompatibility can cause the mother’s blood to attack the red blood cells in the fetus’s Rh-positive blood, making the baby dangerously anemic.

Fortunately, Buckley knew she was Rh-negative. And though her Westminster obstetrician assured her everything with her pregnancy would be fine, Buckley wasn’t convinced.

“The Rh didn’t affect my first two kids, but I knew what it could do, and wanted piece of mind,” says Buckley, 26. “My OB didn’t take me seriously when I said what could happen this time—she thought I was crazy when I did some research and Googling. I chose to go to Sinai Hospital instead to make sure everything was okay, because I was afraid she would’ve missed it.”

What might have been missed was a more severe case of so-called Rh allo-immunization that Sinai maternal-fetal physician Stephen Contag did indeed find—and dealt with in an interesting way.

“This Rh incompatibility is potentially fatal for the fetus if not detected and treated,” says Contag, 53, “because the mother develops an immune response to the baby’s Rh-positive blood, causing the mother’s white blood cells to destroy the baby’s red blood cells. But we’re good at preventing it in the first place.” Assuming, of course, that it’s detected early and prevented with drugs that suppress the mom’s immune response.

Contag’s approach, while relying on a Doppler monitor to check the baby’s blood flow every couple of weeks, was a series of fetal blood transfusions until the baby was old enough to be delivered.

“I did have to caution Stephanie that there was a 2-percent risk of the fetus not tolerating the transfusions, which would require immediate delivery, as early as seven months,” says Contag.

And Buckley’s reaction to that? “I was a wreck—a nervous wreck,” she admits.

But the transfusions worked—another would come after birth, in addition to weeks of monitoring—and baby Payton Copek, now five months old, is doing just fine, thank you.

And about her decision to opt for a hospital an hour from home?

“I wouldn’t change a thing,” says Buckley. “Dr. Contag was amazing, and the hospital was amazing. I’ll actually miss going, as weird as that sounds. If not for him, Payton wouldn’t be here. And Dr. Contag was a therapist, too—he always made me feel better about the situation.”


Medical Miracle No. 5

Dr. Neil Porter
University of Maryland Medical Center

Madisyn Betterson’s frightening illness first appeared in June, “right before school let out,” recalls her mother, Stephanie.

The normally bubbly, active fifth grader at Windsor Mills’s Dogwood Elementary School, who liked to dance, sing, and play with her Yorkie, Tyson, began vomiting, as if she had a stomach virus. But there was another troubling symptom: The 11-year-old was dragging her right leg. Her mother rushed her to the ER at the first of several hospitals where she would eventually seek help. But most merely gave Madisyn fluids for dehydration. As the days passed, however, the symptoms got more distressing: “She was barely able to talk or walk at this point, but she was sent home by one of the several hospitals on the second visit there with them thinking it was conversion disorder, a psychological illness,” recalls Betterson, who works in specialty pharmaceutical sales. “That was the closest we saw to a diagnosis at that point. But it made no sense.”

As her daughter’s condition worsened, Betterson rushed Madisyn—now talking repetitively and unable to stand or control bodily functions—to the ER at St. Joseph Medical Center in the middle of the night, where the perplexed staff referred her to the University of Maryland Medical Center (which now owns St. Joseph’s), where the pediatric ICU paged a neurologist.

Lucky for her, UMMC neurologist Dr. Neil Porter had an inkling of what it was. Spinal-tap results seemed to support his educated guess: It was a rare form of encephalitis (anti NMDA receptor encephalitis). “Instead of it being viral, this strain is auto-immune, almost like lupus, where the body is attacking itself, causing inflammation,” says Porter, 49.

“It’s a pretty easy illness to misdiagnose—here we had a previously healthy girl acting bizarre, but it could be drugs, sexual abuse, psychological. But when we saw her, it was getting worse—she was not responding well to people, and another tip-off was the body jerking, her limbs flailing around uncontrollably. We had seen a number of other cases like this, and said to ourselves, ‘Hey, if that’s what this is, we need to jump on this.’ So we took a calculated risk and started treating her immediately for that while doing other tests to confirm it.”

Madisyn spent 90 days in the pediatric intensive care unit at Maryland. “We were aggressive at the beginning with a gamut of treatments,” says Porter. “There were steroids to suppress inflammation and plasma exchange, which is similar to dialysis, to remove antibodies that are causing trouble. They all worked a bit, but the final thing we tried was something akin to chemotherapy, administering a specific antibody for eight weeks that attacks white blood cells—and then we saw dramatic improvement.” It was at that point she could be moved to Mt. Washington Pediatric Hospital for recovery.

“It’s a long, expensive rehab process,” says her mother, “but she’s now able to walk a little, follow commands, even can talk a little with her trachea tube.”

“One thing to emphasize is that this was really a team effort, involving all the staff—nurses, consultants, therapists, and Mrs. Betterson, too—just a ton of people,” says Porter.

“Seventy percent of these patients do well, which makes me feel more optimistic. I’m optimistic she’ll be back to 100 percent and back to school
in six to nine months.”

Issue date: November, 2013
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