EXPERIENCE COUNTS: Raymond Rupert MD. MBA. Rupert Case Management Inc.

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 A COMPLEX CASE STUDY:

An 81 year old female presented with a six month history of abdominal pain, vomiting, lethargy, depression and a 30 pound weight loss. She developed abdominal pain with vomiting each time that she ate food.

PAST INVESTIGATIONS:

All prior investigations including upper and lower endoscopy, CT abdomen and ultrasounds were normal.

COMMENTS BY FAMILY:

The family was disturbed by the lack of results. They told us this without holding back. All tests were negative. The GI specialists had found nothing. No solutions were being provided that offered any help.

EXPERIENCE COUNTS: 

Research is an integral part of finding solutions to complex problems, however, not all answers exist in the literature and research can sometimes lead to contradictory findings. In addition to research, experience counts.

Drawing on the facts of the case, the available evidence and experience with over 2,000 prior complex cases the creative moment arrived one morning on my walk to the office.

The idea was this patient likely had “intestinal angina” She had a block in blood flow  to her gut.  Each time, she tried to eat, she developed angina type pain of her gut. It seemed to make sense, at least in theory.

 

DEFINITIVE TESTING:

To test the theory, we ordered a CT angiogram or arterial blood flow study of her gut. The results were dramatic. She had severe stenosis or narrowing of the coeliac artery and complete closure of the superior mesenteric artery (SMA) to her gut.

THE PROCEDURE:

We went to work advocating for this patient. We asked a leading interventional radiologist to stent (open up) her blocked arteries. He agreed. He decided to approach the coeliac artery first. He stented this artery. It took about 30 minutes.

THE OUTCOME:

She got better. She could eat with no pain. She was more energetic. She could keep her food down. She and her family were content with the outcome.

THE SUMMARY: 

Finding solutions to complex problems, using research alone has its limitations.

Combining research with real world experience gained from years of clinical work is the key to solving complex problems.

Experience counts.