5 Specialists Team to Solve Medical Mystery
‘Terrible’ Luck Turns Good
Daniel Pironto was raking a season’s worth of leaves at his Edgewater home in spring 2007 when he noticed his neck stiffening. Over the following weeks, he suffered steadily worsening neck pain.
A computed tomography (CT) scan and a magnetic resonance imaging test (MRI) indicated the 67-year-old retired Washington Post mail room employee had degenerative joint disease in his neck. When physical therapy failed to help, Mr. Pironto landed in the office of orthopaedic surgeon Dr. Alessandro Speciale, M.D., both hands bracing his neck to stave off the pain.
His case turned out to be more complex than arthritis, bringing together the minds and talents of a multi-disciplinary, multi-talented team of physicians at Anne Arundel Medical Center. In addition to Dr. Speciale, neurosurgeon Gary Dix, M.D., otolaryngologists Gregg Heacock, M.D. and Joydeep Som, M.D., infection control specialist David Barnes, M.D., and anesthesiologist Jim Boulier, M.D., were on the case.
The teamwork and immediate access to so many specialists, he says, saved his life.
“Mr. Pironto’s neck was unstable, and he was at risk for paralysis,” said Dr. Speciale, who was the first of the specialists to evaluate Mr. Pironto. New tests indicated “an aggressive, destructive lesion in bones on the top of his neck. I put him in a cervical collar and had him admitted to the hospital for evaluation for a tumor.”
Dr. Speciale consulted with neurosurgeon Gary Dix, and they agreed to stabilize the patient’s neck and obtain a biopsy. Problems with Mr. Pironto’s airway before surgery brought in otolaryngologist Gregg Heacock. Mr. Pironto, by now in the Critical Care Unit, then was brought to surgery.
But Dr. Dix found nothing amiss. He and Dr. Speciale stabilized the neck with plates and screws, took a small portion of bone from the patient’s hip and laid it along the spine, where it eventually would fuse to provide strong support.
Mr. Pironto was turned over on the operating table to allow the surgeons to examine his neck through his mouth. First, Dr. Heacock and Dr. Som removed the breathing tube and performed a tracheotomy, allowing the patient to breathe.
“We made an incision in the back of the throat to gain access to where this mass was,” explained Dr. Speciale. “The area was very inflamed and there was thickened, abnormal-looking tissue. A pathologist examined the biopsy immediately and reported the patient had a staphylococcus infection, commonly known as staph. We removed as much as we could to stimulate blood flow to the area, then started him on intravenous antibiotics.”
Dr. Speciale said spinal infections such as Mr. Pironto’s are unusual, especially at the base of the skull. “In this case, it was terrible luck.”
The bad luck lasted just a short while before it turned good for Daniel Pironto. After several weeks taking antibiotics and wearing a neck brace, his life began to return to normal. “I feel good and I don’t have any pain,” he said. “But I don’t know about raking leaves again.”
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