Medical Mystery solved at Birmingham VA

A physician resident training at Birmingham VA is credited with a life changing discovery. University of Alabama at Birmingham physician resident Dr. Matt Slief discovered an obscure diagnosis that resolved refractory orthostatic hypotension in a Veteran patient.

The mystery

Air Force Veteran James Kent was experiencing frequent lightheadedness when he would stand up, almost to the point of fainting. One day while working as a volunteer at Birmingham VA, he experienced a severe episode and was rushed to the emergency department.

He was treated for orthostatic hypotension, a health issue which leads to inadequate blood flow to the brain when someone stands up. He was familiar with the diagnosis, as he had been suffering from this condition for several years, but only recently was it getting worse. The treatments Kent had been given were not working like they should have, deeming his case a mystery.

Dr. Robert Centor, Birmingham VA attending physician, challenged his team to figure out the underlying issue. Slief was up for the challenge and thoroughly reviewed the patient’s history. He presented a potential cause and solution to Centor that was highly unusual.

The solution would be to remove a filter in the main vein—the inferior vena cava—that was placed in the patient 15 years ago to block blood clots from reaching the lungs. Slief reasoned that the filter caught the clots as intended, but in doing so, a blockage occurred over time and prevented blood from returning to the heart when the Veteran stood up.

“I thought it was a very interesting idea,” said Centor. “I’ve never heard of a case like this before, but I told him let’s explore it.”

The solution

As a potential solution, there was no way to prove the hypothesis until the filter was removed and the results confirmed effective.

Left to right: Dr. Matt Slief, Veteran James Kent, Dr. Robert Centor

“We knew his symptoms of orthostatic hypotension were interfering with his life without much relief from treatment,” said Slief. “The solution to remove this filter was rare and unheard of, but it seemed to be our most likely solution for Mr. Kent.”

“Once we had the idea, we confirmed it was the likely problem by using imaging with ultrasound and then CT scanning that showed no blood was flowing in the inferior vena cava above the filter,” said Centor. “These studies were necessary before the surgeon would agree to the complex procedure.”

After hearing about the possible solution to his health problem, Kent was on board to follow through with the surgery. Dr. Bill Parkhurst, a surgeon at University of Alabama at Birmingham, specializes in this kind of procedure and agreed to move forward with the operation.

The results

“It worked!” says Kent. “I am feeling 100% better and I am eternally grateful for Dr. Slief for finding what the problem was. I could not be happier with the team of physicians who cared for me, including Dr. Centor and Dr. Parkhurst.”

Kent is now living his life with little to no symptoms of orthostatic hypotension thanks to the physicians working together as a team to solve a rather unusual case.

“I’m proud of Dr. Slief for thinking outside of the box,” said Centor. “Being able to help someone in situations like Mr. Kent is the greatest pleasure of being a physician.”

The two doctors plan to publish a medical report about this rare orthostatic hypotension case for other medical professionals to learn from. The case was featured in a New York Times article, “When he stood up quickly, he sometimes fainted. What was it?”

“Collectively, it was a team effort to help this Veteran,” said Slief. “Most importantly, the Veteran is back to living his life and has regained some of the things his orthostatic hypotension had taken away from him for years. The recognition by the New York Times was just icing on the cake.”