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Interdisciplinary Teamwork Saves Patient

Multiple BCH specialties work together during Lindsey Brown’s unique case

When he first met Dr. Austin Poole, it was difficult for Lindsey Brown to walk. His legs had swelled due to massive blood clots. Worse yet, some clots had broken free due to a hole in his heart, causing small strokes.

At the start of 2019, Brown had been healthy and active – skiing, riding his bike and going to the gym three times a week. Brown then started to have “annoying little discomforts in my chest” that turned into chest pains that sometimes made it hard for him to breathe. On May 1, 2019, Brown had bypass surgery (not at BCH) after he learned all the arteries going to his heart were blocked.

He was in and out of area hospitals for the next few months as his condition deteriorated - strokes, bleeding ulcers, dehydration as well as the swelling in his legs that made mobility difficult.

“I had a doctor at a different hospital ask me if I wanted to die because of a stroke or because I bled to death,” said Brown, who is a retired school bus driver and firefighter. “The doctors I had consulted didn’t want to do anything because one way or another it would have killed me.”

One physician assistant had a recommendation for who the 69-year-old Dacono resident should turn to: oncologist and hematologist Dr. Austin Poole with Rocky Mountain Cancer Centers.

“Dr. Poole looked at my legs and just shook his head,” Brown recalled. “He went and got a wheelchair and wheeled me over to Foothills Hospital and admitted me right on the spot.”

After Brown was admitted to Foothills Hospital, a team of BCH physicians worked quickly to determine a plan of action to prevent his legs from developing life-inhibiting post thrombotic syndrome, a condition that can cause chronic pain, swelling and other symptoms as the result of deep vein thrombosis. Complicating Brown’s case was the fact he couldn’t have the standard treatment of blood thinners because of extensive bleeding in his intestines.

Physicians from Cardiology, Interventional Radiology and Oncology/Hematology, as well as many other BCH team members, collaborated for several hours to meld their specialized techniques and technologies into a comprehensive treatment plan.

Cardiologist Dr. Srinivas Iyengar, Boulder Heart’s Structural Heart Program Director, said specialists at other area hospitals would not treat Brown because of the risks associated with performing the necessary, demanding procedures.

“We felt, given the collegial nature of BCH as well as our shared experience, that we had to try and give (Lindsey) our best shot,” said Dr. Iyengar, who recalls Brown’s case as one of the most challenging of his career.

Dr. Iyengar closed the hole in Brown’s heart to prevent additional clots going to his brain and fixed Brown’s vein graft. Notably, Dr. Iyengar also performed the advanced Patent Foramen Ovale (PFO) closure through the neck, since Brown’s veins were blocked in his legs. This technique is done in less than one percent of all PFO closure cases worldwide. Dr. Poole then started Brown on a carefully managed treatment of blood thinners. Only then could BCH interventional radiologist Dr. Thomas Fahrbach perform a mechanical thrombectomy (one of the newest procedures available at BCH) to remove the clots and reconstruct the veins in his legs, pelvis and abdomen – relieving the massive swelling and setting Brown on the road to recovery. Dr. Fahrbach also removed a filter that another medical facility placed in Brown’s chest to eliminate the possibility of blood clots getting to his brain.

“More than any other place I’ve worked, BCH has created an environment that fosters collaboration between all specialties without the silo mentality often found in medical facilities” Dr. Fahrbach said. “When you have good people working together, it’s amazing what can be accomplished.”

‘I’m Absolutely Thankful to BCH’

“I was just very thankful for BCH,” Brown recalled. “If it hadn’t been for Dr. Poole, I might not be sitting here right now. All the BCH doctors as a team played a valuable role in my recovery, but Dr. Poole was instrumental in everything.”

From the team at BCH, Brown learned that he has a unique propensity to develop ulcers and blood clots. Dr. Poole is still managing his blood thinner treatments, but Brown doesn’t have any other medical procedures in his future.

“This case taught me the value of interdisciplinary teamwork and how it can directly lead to success with patient care. It’s so much fun to work with other great physicians and members of the health care team who do amazing things in their realm of medicine,” Dr. Fahrbach said. “The day we stop learning from others in medicine is the day we stop progressing.”