Area Doctor Flip-Flops In Face of Criticism from Informed Mother

We were copied on the following letter from Dr. Bloom to Dr. Rzepka. Some content excluded for brevity's sake where indicated by ellipses, which the editor thinks are cool. Editor also reserves the right to add commentary.

Date: May 3, 2007

To: Andrew Rzepka MD, Pediatrics, Park Nicollet

Re: ALICIA G FULLER

This is a quick note regarding ALICIA FULLER for the following concern:

As we had discussed on the telephone, I saw Alicia and her mother in my office on April 30, 2007. As you are well aware she is an ex-premature young girl with a number of vascular lesions (some deeper and some more superficial) on her face, trunk and extremities....The mother is quite concerned regarding their continued growth. The patient has previously been evaluated by Dr. James Sidman who had recommended imaging and a biopsy.

The visit today was sub-optimal as the mother as an advocate for her child had specific ideas about what needed to be done including excising the lesion on the face [Dr. Sidman's idea, not Michelle's--Ed.]. Since the visit, I have given additional thought to her child's lesions. While these are likely to be superficial and deep hemangiomas, the fact that at 17 months they are continuing to grow does raise the question of whether these could [be] blue rubber blebs which would carry a different genetic and prognostic risk (bleeding).

I would ask that you consider the following:
(1) Obtain MRI with contrast of the head, chest, liver and spleen as well as CBC with differential and liver function tests [which the mother had requested and I had categorically denied].
(2) Refer the patient to hematology and oncology for a work-up of possible Factor V Leiden heterozygosity [which I had never heard of until Michelle mentioned it, but I looked it up later].
(3) Consider having Dr. Marie Christensen at Park Nicollet (plastic surgery) excise a small deeper non-facial lesion for diagnostic biopsy purposes....

If the diagnosis becomes blue rubber bleb syndrome, then a genetic and further dermatologic (and potentially hematologic) intervention would be in order....

Sincerely,

Kenneth E. Bloom, MD