A multidisciplinary approach
The final piece of Ms. Altbach and Dr. Patton's theory - endometriosis in or near the chest cavity - could be confirmed through a laparoscopic surgery called endometriosis excision surgery.
Armed with new knowledge and a potential diagnosis, Ms. Altbach sought out Tamer Seckin, MD, a leading endometriosis expert and gynecologic surgeon at Lenox Hill. Dr. Patton asked Dr. Seckin to join him in the operating room for Zara's second pleurodesis procedure the next day.
"Dr. Seckin listened to my story and what was going on with me," Ms. Altbach said. "He told me he would do his best to make it and he did. He made time at the very last minute to join the surgery with Dr. Patton."
Dr. Patton and Dr. Seckin operated side-by-side with each investigating a different area of the body. Dr. Seckin went first.
"It was extensive," he said of the endometrial lesions. "Diagnosis was made at that time, so we knew exactly where those lesions were coming from."
Within the pelvis Dr. Seckin found lesions on Ms. Altbach's ovaries, fallopian tubes and uterus, and within the abdomen on the diaphragm. But, whether endometriosis was the cause of her lung collapse was still in question. Dr. Patton picked up from there.
He discovered abnormal lesions on the top half of the diaphragm, which separates the heart and lungs from the abdominal cavity. This confirmed a diagnosis of catamenial pneumothorax.
Dr. Patton removed the lesions and re-attached her lung to the chest wall.
"Traditionally, the surgeries would be done separately because they're in different body cavities," Dr. Patton said. "But, since we both operate minimally invasively, it just made sense to do them at the same time. This way patients only have to come into the hospital once. They only have to go through anesthesia once."
Since teaming up for Ms. Altbach's treatment, Dr. Patton and Dr. Seckin have worked together on multiple catamenial pneumothorax patients – a practice she hopes more doctors adopt.
"It's a multidisciplinary approach to a multi-organ disease," Dr. Seckin said. "Zara was the icebreaker. She connected our two departments."