Imagine your favorite food. Now imagine that simple act of eating being taken away from you. Too often we take for granted the small and simple things that make life so enjoyable.
The following story is proof that the small things, such as the ability to eat, sometimes end up being the big things in life.
Thank you to Elizabeth Martin and The Digestive Disease Institute at Virginia Mason (DDI) for sharing.
A New Appreciation for eating
Fernando Fraga is a 39-year-old artist who has visited dozens of cities exhibiting his work. Recently he journeyed from his native Uruguay to Seattle, not to celebrate art, but to regain a normal life.
A tuberculosis infection of the lymph nodes in Fernando’s chest ravaged his esophagus, causing a life-threatening perforation. Surgery in Uruguay to remove the heavily damaged organ saved his life but resulted in a one-month hospital stay, leaving Fernando dependent on a feeding tube. A bag affixed to the side of his neck to catch saliva was a painfully visible mark of his illness. After the operation, the tuberculosis required eight more months of treatment before reconstruction could be considered. The only way back to the life he knew before meant restoring the ability to eat normally. Fernando had not eaten or taken any fluids by mouth for 10 months.
Fernando’s gastroenterologist in Uruguay, Henry Cohen, MD, FACG, contacted Richard Kozarek, MD, executive director of the Digestive Disease Institute at Virginia Mason (DDI) and recent president of the World Gastroenterology Organisation (WGO). Given Dr. Kozarek’s role, Dr. Cohen knew where to turn to help his patient. The question was where could Fernando safely undergo the extremely difficult surgery to reconstruct his esophagus, in a chest cavity riddled with scar tissue? The answer was the Esophageal Center of Excellence, part of the DDI at Virginia Mason. Under the direction of surgeon Donald Low, MD, FACS, FRCS(C), the mortality rate in more than 600 esophageal resections at Virginia Mason is less than 0.5 percent, compared with a national average of about 7 percent. There are no better published results in the world.
“First, we thought of travelling somewhere near Uruguay, then to other clinics inside the United States,” says Fernando. “But after seeing the curriculum vitae of Dr. Low, we knew he was the one we were looking for. We were afraid because it was really far away, it was the longest trip we could have chosen inside the U.S., and we didn’t know if I could endure the trip with my feeding tube.”
Fernando became acquainted with the DDI team long before he got on the plane. Sonia Kunz, RN, and Jean Hong, ARNP, worked to set up the rapid series of consults and procedures he would need on his arrival and stayed in regular contact with Fernando and his family. Dr. Low sent a letter from England, where he was presenting at a conference, to reassure Fernando about the planned treatment.
“After the first contacts with Dr. Low and his team, we knew that Virginia Mason was the best decision we could have made,” says Fernando. “They gave us so much confidence and peace. It seemed that they knew us from long ago.”
Surgery to restore esophageal function typically refashions the stomach to replace the organ. To ensure Fernando’s stomach was appropriate to use to reconstruct the esophagus, he underwent a procedure known as gastroscopy. This procedure involves inserting an endoscope — a thin, flexible instrument with a light and camera — into the body, which then transmits images to a viewing screen.
In Fernando’s case, the pediatric endoscope had to enter the small bowel through the orifice created for his feeding tube to pass up the bowel into the stomach. This atypical procedure was managed in the DDI’s Therapeutic Endoscopy Center of Excellence. Dr. Kozarek performed the gastroscopy and was able to assure the team his stomach was appropriate to use to restore Fernando’s ability to eat normally.
After months of planning and traveling 7,000 miles from home, Fernando and his surgical team made a bid for a renewed life of eating and swallowing, a life without the bag he could never hide. Virginia Mason ENT (ear, nose and throat) surgeon Stephen Bayles, MD, FACS, opened Fernando’s neck to mobilize the remaining short stump of esophagus. Dr. Low accessed Fernando’s abdominal cavity to reshape his stomach from a bag into a long tube that was extended up the neck. A normal esophagus resides behind the heart and in front of the spine. In Fernando’s case the area was heavily scarred due to his perforation. To bypass the damaged area, Dr. Low created a tunnel behind the breast bone and in front of the heart to reconnect the stomach tissue with Fernando’s remaining esophagus.
Normally a patient undergoing esophageal resection, even one less complicated than Fernando’s, could expect a 10- to 15-day hospital stay. Fernando stayed five days. Dr. Low encouraged Fernando to stay in Seattle for at least a week to recuperate following surgery. During his recuperation, Fernando created gifts of paintings for the members of his care team.
“It was very important for me, coming from another country and speaking Spanish to have my family with me, encouraging me all the time. To walk, to do the exercises, to get well,” says Fernando.
Dr. Low also credits Fernando’s remarkable outcome to the highly experienced, highly coordinated clinical team that is garnering international recognition. In 2011, the Esophageal Center of Excellence hosted visiting physicians from the United States, Europe and Australia to learn firsthand how a coordinated care team in a high-volume center can improve outcomes and enhance recovery for patients.
Before leaving Seattle, Fernando tasted his first soft food in more than a year, the same way anyone else would.
The Digestive Disease Institute at Virginia Mason (DDI) is recognized as a leader in the multidisciplinary care of digestive disorders and has received international acclaim for excellent survival rates of colon, esophageal and pancreatic cancer patients. For more than 20 years, DDI’s teams of expert physicians and staff have collaborated to achieve breakthroughs in digestive disease, translating their findings into improved patient outcomes and advanced quality care.
In 2011, Virginia Mason received the 2012 HealthGrades Gastrointestinal Care Excellence AwardTM for the third year in a row. Virginia Mason also ranked No. 1 in Washington for GI Services and GI Medical Treatment, according to HealthGrades’ 2011 Healthcare Consumerism and Hospital Quality in America report.