Brewing a great doctor-patient relationship

20150422_BrookeStarbucks-14“I love working with Brooke and her mom. They are a great pair, and Brooke has grown into a wonderful, independent young woman who can advocate for herself. She went from being a sweet kid who couldn’t walk five steps without pain to this vibrant college student who treks over here from Northeastern University, bringing me a latte, ready to conquer the world,” says Dr. Kate Ackerman, medical director of Boston Children’s Hospital’s Female Athlete Program.

Brooke Lombardi, her mother Shari and Ackerman have a pretty special relationship. Brooke, who grew up in Miami, started seeing Ackerman in 2010 when she was 15. Today, Ackerman helps Brooke, a college student who continues to have minor medical issues, navigate the health care system, helping to provide a safety net for a young adult far from home.

Brooke’s compartment syndrome and elective surgery

When Brooke was in 6th grade, she started experiencing leg pain while walking or running. “We thought it was shin splints,” recalls Shari. The pain continued, and Brooke’s doctor recommended a bone scan. The results were normal.

Brooke did her best to cope with her symptoms, which included sharp pain, aches and numbness in her legs. Three years after the symptoms first appeared, Shari mentioned Brooke’s symptoms to a podiatrist, who suggested an MRI and pressure test. These showed muscle swelling leading to high pressure measurements in her legs.

Brooke was diagnosed with chronic compartment syndrome (the pressure in her calf muscles limited the amount of blood and oxygen reaching her muscles, resulting in leg pain).

She was referred to a Miami-area surgeon for a fasciotomy, an operation that involves cutting the fascia (the tissue encasing the bundles of muscles, nerves and blood vessels) in her legs to reduce the pressure built up by blood flow and muscle expansion.

The surgery did not relieve Brooke’s pain, and tests showed she still had high pressure in her legs, indicating she still had compartment syndrome. It was a disappointing outcome after an elective surgery.

From Miami to Boston

“My parents said, ‘We need the best of the best,’” says Brooke. They found Boston Children’s and scheduled an appointment with Ackerman.

“I sent her a long email with Brooke’s history. She said, ‘Send me everything on Brooke.’ I didn’t realize it then, but she was emailing back and forth with me about Brooke’s case while in Montana where she was getting married,” recalls Shari.

The trio met a few weeks later.

Ackerman started to solve the mystery of the teen’s chronic compartment syndrome.

Brooke fell in love with the city of Boston.shutterstock_134182514

And Shari and her daughter developed a ritual. Before every appointment at Boston Children’s, they would stop at Starbucks, picking up their favorite coffee drinks.

Mother and daughter quickly discovered Ackerman’s preferred drink and started to bring her a latte when they visited. Their shared love of caffeine helped to cement a great doctor-patient relationship, and Ackerman’s approach to patient care resonated with Shari and Brooke.

Shari found the expertise and personal touch that she knew her daughter needed. “Dr. Ackerman read everything we sent and kept researching Brooke’s conditions. On top of that, she didn’t just send us to Dr. Micheli for Brooke’s next appointment. She walked us to his office and introduced us to him.” She also considered Brooke’s complicated history, including a congenital heart condition, growth issues and immune deficiency, and helped coordinate care with other specialists.

Micheli scheduled Brooke for a second fasciotomy that November. The surgery provided some relief, but Brooke’s symptoms returned the following year.

For Brooke’s third operation, Micheli decided on a different surgical approach and brought in two more surgeons. Working together in the operating room, they were able to safely release two compartments in each leg, obtain muscle biopsies and perform complicated fasciectomies (removing the muscle casing). It worked.

During Brooke’s high school years, she and Shari continued to make the trip from Miami to Boston at least twice a year, checking in with Ackerman during follow-up appointments and solidifying the relationship. Brooke contended with several other health issues, including infections and rashes likely related to her impaired immune function.

“Dr. Ackerman helps to piece everything together,” says Brooke.

So when it came time to look for college, Boston seemed like a natural fit. “I had fallen in love with the city, and my parents were very comfortable with me coming here. They knew I had good doctors here.”

Today, when the little things pop up for Brooke, like a rash or neuroma, she does what good patients do. She connects with Ackerman. And Ackerman makes sure to connect Brooke with the care she needs.

Learn more about the multidisciplinary care provided by Boston Children’s Female Athlete Program.

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