A Devastating Diagnosis with a Miraculous Recovery
The following events occurred between March 2017 and June 2018.
Growing up, Kathy Karam, of Ocala, never intended to become a nurse. But when her husband, Rich, developed a sudden illness, she became his caregiver without hesitation.
On March 3, 2017, Rich played a game of softball, ate lunch and, abruptly, experienced stomach pain. Moments later, Kathy found him lying on the floor and rushed him to a nearby emergency room. After a series of tests, doctors believed that Rich suffered from gastritis, better known as inflammation of the stomach lining, or peptic ulcer disease, better known as stomach ulcers. And while both gastritis and peptic ulcer disease are not lethal and are easy to treat, something more ominous was looming.
Their recommendation? Bed rest and a call to his gastroenterologist the following week.
Upon examining him, Rich鈥檚 gastroenterologist ordered a battery of tests for completion by the end of the day. Before Rich and Kathy could call the following day for the results, Rich鈥檚 physician called them.
鈥淗e said, 鈥楪et him to the hospital immediately. They鈥檙e waiting for him. He has dissection of the superior mesentery artery,鈥欌�� Kathy said.
Dissection of the superior mesentery artery, or SMA, prevents blood from traveling to the bowels, which can result in dead and dysfunctional bowels. The results can be catastrophic.
When Rich arrived at the hospital, doctors placed a stent in the SMA to restore blood flow to his bowels and gave him heparin, a blood thinner, to prevent blood clots.
Despite the procedure, Rich鈥檚 stomach pain persisted. Five days later, upon a second examination, physicians told Rich and Kathy the stent had failed. It had occluded, meaning that it clotted and flow was once again limited to the small bowel.
Hopes fading, and at their wits鈥� end, Rich and Kathy were referred to BOB体育 Shands Hospital in Gainesville.
Kathy and Rich had only heard of BOB体育 in passing, but they were familiar with the concept of an academic health center. Originally from Massachusetts, Kathy and Rich both knew that academic health centers meant access to research, technology and advanced expertise.
At BOB体育, doctors reviewed Rich鈥檚 medical record and spoke frankly with Kathy.
鈥淭hey said, 鈥榃e鈥檙e going to have to get the team together because we don鈥檛 know if we鈥檙e going to be able to save his life,鈥欌�� Kathy said.
Thomas Huber, M.D., Ph.D., the chief of vascular surgery and endovascular therapy at the UF College of Medicine, performed Rich鈥檚 first bypass surgery to restore flow to his small bowel from the aorta to the SMA. Once again, Rich was prescribed heparin, only for doctors to learn that he was allergic to the drug. Instead of thinning Rich鈥檚 blood, the drug did the opposite and contributed to blood clotting 鈥� a very rare allergic reaction known as heparin-Induced thrombocytopenia. Rich鈥檚 bowels continued to be deprived of oxygen-rich blood flow, resulting in dead intestine.
Then, another hurdle emerged: sepsis.
鈥淢y son was here, we called the girls and we said, 鈥榊ou gotta come down, we鈥檝e got to decide what we鈥檙e going to do because they don鈥檛 know if dad鈥檚 going to make it or not,鈥欌�� Kathy recalled. 鈥淭hey came down and we thought about letting him go, but the doctor took us in an office and said, 鈥楾his is a treatable disease, but it鈥檚 going to be a long road.鈥欌��
A second bypass was performed by BOB体育 acute care surgeons Frederick Moore, M.D., FACS, MCCM, and Martin Rosenthal, M.D., FACS, director of the BOB体育 Abdominal Wall Reconstruction and Intestinal Rehab Program, along with a team of clinicians. After an arduous and complex procedure, Rich鈥檚 incision was kept open because closing the abdominal wall was fraught with danger.
Kathy said, 鈥淭hey (the physicians) explained everything to us. The bowels were like a hard ball and they couldn鈥檛 separate them (referred to viscera en bloc). Every time they tried to, the bowels would shred, so they had to leave him open.鈥�
Unable to eat or go to the restroom, Rich was connected to a number of tubes for medication and bile collection to refeed downstream in his distal GI tract. Rich recovered in the intensive care unit for just over seven weeks.
As Rich healed, doctors performed a skin graft to cover his open wound by taking skin from Rich鈥檚 upper thigh and stretching it to cover the opening after meshing it to minimize tissue loss from his leg. Doctors also placed Rich on total parenteral nutrition, or TPN, which feeds nutrients to the body intravenously.
Later, Rich was sent to rehabilitation closer to home in The Villages庐 for five weeks.
Like many people who have survived a serious medical condition, Rich required at-home care 鈥� which can be daunting, and comes with its own learning curve. Kathy learned how to take care of her husband鈥檚 wounds and administer his many medications.
On top of many caregiver tasks, Kathy learned how to change Rich鈥檚 fistula bag, a pouch used to collect bile.
Over the course of many months in recovery, Rich experienced infection and inflammation of his heart, known as endocarditis, which required two type of antibiotics.
Rich and Kathy made another trip to Gainesville when doctors discovered that Rich had a perforated gallbladder. He was readmitted to the hospital, and his care team discovered he had low blood pressure.Then, another roadblock appeared.
鈥淭he hardest part was not knowing from one day to the next was what it was going to be like,鈥� Kathy said. 鈥淚 never knew what I was going to deal with.鈥漌hile Rosenthal and his team worked to regulate Rich鈥檚 blood pressure, Kathy allowed herself to cry in the hallway. The recurrent health problems and uncertainty were taking their toll.
Once Rich recovered after the previous series of surgeries and infections, Rosenthal discussed the next integral step in Rich鈥檚 long-term health: abdominal reconstruction.
On Feb. 15, 2018, they celebrated two special occasions: Kathy鈥檚 birthday and Rich鈥檚 abdominal wall reconstruction. Rosenthal and his team were able to take Rich鈥檚 fistulas down and break up the extensive scar tissue in his abdomen. Then, in a second operation, doctors reconstructed Rich鈥檚 large loss of large hernia through a complex surgery. In addition, Rosenthal removed Rich鈥檚 gallbladder. It was a day to rejoice as Rich had all of his skin graft and tubes removed. Then, in June 2018, Rich was taken off TPN, becoming free of pumps and lines, and was able to begin eating solid foods.
Although they鈥檙e glad to no longer be in an out of doctor鈥檚 offices 鈥� Kathy and Rich were able to spend only a few weeks at a time at home during Rich鈥檚 medical journey 鈥� they鈥檙e grateful for the support they received from their health care team.
鈥淭he teams up here at BOB体育 Shands not only treat the patient, they treat the whole family,鈥� Kathy said.
In 2019, Kathy and Rich celebrated their 50th wedding anniversary 鈥� hospital-free.
鈥淚 just went along for the ride,鈥� Rich said, reflecting on everything they had been through. 鈥淪he was my rock.鈥�
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