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’s 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’s physician called them.

“He said, ‘Get him to the hospital immediately. They’re waiting for him. He has dissection of the superior mesentery artery,’” 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’s 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’ end, Rich and Kathy were referred to UF Health Shands Hospital in Gainesville.

Kathy and Rich had only heard of UF Health 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 UF Health, doctors reviewed Rich’s medical record and spoke frankly with Kathy.

“They said, ‘We’re going to have to get the team together because we don’t know if we’re going to be able to save his life,’” Kathy said.

Thomas Huber, M.D., Ph.D., the chief of vascular surgery and endovascular therapy at the UF College of Medicine, performed Rich’s 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’s blood, the drug did the opposite and contributed to blood clotting — a very rare allergic reaction known as heparin-Induced thrombocytopenia. Rich’s bowels continued to be deprived of oxygen-rich blood flow, resulting in dead intestine.

Then, another hurdle emerged: sepsis.

“My son was here, we called the girls and we said, ‘You gotta come down, we’ve got to decide what we’re going to do because they don’t know if dad’s going to make it or not,’” Kathy recalled. “They came down and we thought about letting him go, but the doctor took us in an office and said, ‘This is a treatable disease, but it’s going to be a long road.’”

A second bypass was performed by UF Health acute care surgeons Frederick Moore, M.D., FACS, MCCM, and Martin Rosenthal, M.D., FACS, director of the UF Health Abdominal Wall Reconstruction and Intestinal Rehab Program, along with a team of clinicians. After an arduous and complex procedure, Rich’s incision was kept open because closing the abdominal wall was fraught with danger.

Kathy said, “They (the physicians) explained everything to us. The bowels were like a hard ball and they couldn’t separate them (referred to viscera en bloc). Every time they tried to, the bowels would shred, so they had to leave him open.”

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’s 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® for five weeks.

Like many people who have survived a serious medical condition, Rich required at-home care — which can be daunting, and comes with its own learning curve. Kathy learned how to take care of her husband’s wounds and administer his many medications.

On top of many caregiver tasks, Kathy learned how to change Rich’s fistula bag, a pouch used to collect bile.