MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. – Distance can be deadly. Located in the Ozarks in Missouri, Fort Leonard Wood is well known for being a remote post. When a baby was born there recently with a suspicious heart murmur, a perceptive doctor at her first assignment and a tele-echo procedure put the newborn on the path to health.
“When I listened to the baby’s heart he had an unmistakably abnormal murmur - very loud and harsh,” said Capt. (Dr.) Kaitlyn Bixel, the pediatrician at General Leonard Wood Army Community Hospital who examined the baby a handful of hours after his birth.
Checking his vitals further reassured her that he was generally healthy, but the characteristics of the murmur made her certain that he had some form of heart defect. She needed more answers.
“I didn’t want to ignore the murmur and risk having him deteriorate overnight, but also I didn’t want to overreact and transport the baby away from his family without a good cause,” said Bixel.
The COVID-19 pandemic has greatly developed the nascent telehealth capabilities at military treatment facilities around the world. Prior to the pandemic, Madigan Army Medical Center on Joint Base Lewis-McChord, Wash., was gradually advancing its telehealth efforts with virtual appointments conducted through telephone and video technology. The virus hastened the use of this tech by sheer necessity.
Remote consultations between physicians and specialists is one area that was developing prior to the pandemic. Bixel and a colleague visited Madigan last year to receive training in how to perform echocardiograms from Madigan cardiologists, technologists and staff and has been performing tele-echos – a set-up where the physician onsite does the procedure with a specialist watching on a computer at their location – for a year now.
But, on the day of this small patient’s birth, it snowed and the clinic closed early, removing the option to use the typical equipment and staff for the procedure. They had to improvise, but made it work.
Having a cardiologist consulting was heartening.
“I was very grateful to have a pediatric cardiologist available to consult right away after discovering the murmur. I was extremely relieved when Dr. Leisemer agreed to assist me with obtaining an echo immediately, because I would not have been able to sleep well that night without doing something to check on the baby’s heart,” Bixel said.
Lt. Col. (Dr.) Kirk Liesemer, the Madigan pediatric and fetal cardiologist watching over Bixel’s shoulder for the 25 minutes the procedure lasted, gives all the praise to his counterpart with hands on the patient.
“The baby probably would have developed difficulty breathing and having the energy to feed over a matter of days,” he said, recognizing that her quick thinking in obtaining an echocardiogram with a cardiologist consulting early on meant the transportation to a facility capable of performing the heart surgery the baby would ultimately need for survival could be arranged and not end up as an emergent situation down the line. “As it was, the baby was safely transported with a known diagnosis urgently, but deliberately.”
The tele-echo identified a major, and rare, heart defect called truncus arteriosus in which a single common blood vessel comes out of the heart instead of the usual two.
The baby was transported roughly two hours away to a pediatric heart center in St. Louis, Mo. There, the diagnosis was confirmed, the baby successfully underwent heart surgery, has been released home to his family and is set for his first follow up visit with his pediatrician, Dr. Bixel.
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