Finding Answers, Finding Relief: Kristina's Story

Krsti­na H. remem­bers when eat­ing a meal meant plan­ning for what would hap­pen after­ward. For near­ly two years, food came with pain and dis­com­fort, and she strug­gled to gain weight.

She saw mul­ti­ple physi­cians and sur­geons, search­ing for answers and a way to feel bet­ter. Her pri­ma­ry care physi­cian, Elias J. Koliopou­los, MD, an inter­nal med­i­cine physi­cian with Duly Health and Care, iden­ti­fied the cause of her symp­toms as supe­ri­or mesen­teric artery (SMA) syndrome.

Krsti­na con­tin­ued to have dif­fi­cul­ty main­tain­ing or gain­ing weight through diet alone. As she explored her treat­ment options, she con­nect­ed with Jihad Kudsi, MD, ABOM, MBA, MSF, FACS, sur­geon and Chair of Surgery with Duly Health and Care, who con­firmed the diag­no­sis and helped deter­mine the next steps in her care.

Find­ing the Right Path Forward

SMA syn­drome is a rare con­di­tion in which part of the small intes­tine becomes com­pressed between two major blood ves­sels. After review­ing Krstina’s diag­no­sis and her ongo­ing symp­toms, Dr. Kudsi con­firmed the con­di­tion and helped guide her through her treat­ment options.

The con­di­tion can be dif­fi­cult to diag­nose because symp­toms such as nau­sea, vom­it­ing, bloat­ing, feel­ing full quick­ly, dif­fi­cul­ty tol­er­at­ing food and sig­nif­i­cant weight loss can mim­ic oth­er gas­troin­testi­nal problems.

“Patients often go through years of mis­di­ag­no­sis before some­one puts the pic­ture togeth­er,” Dr. Kudsi said.

If you’ve been liv­ing with ongo­ing diges­tive symp­toms or unex­plained weight loss, you don’t have to keep guess­ing. Sched­ule a vis­it with Duly Pri­ma­ry Care to talk through what you’re expe­ri­enc­ing and get con­nect­ed with the right spe­cial­ists for answers. >

For Krsti­na, hav­ing an expla­na­tion for what she had been expe­ri­enc­ing was an impor­tant step for­ward. Find­ing a physi­cian who took the time to lis­ten to her and explain what was hap­pen­ing was just as important.

“Oh, he was incred­i­ble,” she said of her first impres­sion of Dr. Kudsi.

What stood out from their first meet­ing was how he approached her care.

“He just real­ly lis­tened to me and let me explain my whole jour­ney before giv­ing any of his thoughts and per­spec­tive,” she said.

He walked her through her options and explained his rec­om­men­da­tion, giv­ing Krsti­na the infor­ma­tion she need­ed to feel com­fort­able mak­ing a decision.

“He made sure I under­stood before decid­ing next steps,” Krsti­na said. ​“He even encour­aged me to get a sec­ond opin­ion and gave me refer­rals to Mayo Clin­ic and oth­ers to speak with.”

That approach gave Krsti­na con­fi­dence in mov­ing for­ward. She chose to stay local and have her surgery with Dr. Kudsi, con­tin­u­ing the rela­tion­ship with Duly she has had since she was 16.

“I think the biggest thing was that Dr. Kudsi made me feel so com­fort­able, and his expe­ri­ence with robot­ic and bariatric surgery gave me con­fi­dence that I was in very good hands,” she said. ​“I real­ly didn’t want to go fur­ther away.”

Cre­at­ing a New Path Forward

SMA syn­drome occurs when the duo­de­num, the first part of the small intes­tine, becomes com­pressed between the aor­ta and the supe­ri­or mesen­teric artery. Nor­mal­ly, a cush­ion of fat helps main­tain enough space between the blood ves­sels for food to pass through. Sig­nif­i­cant weight loss can reduce that cush­ion, nar­row­ing the space and caus­ing the duo­de­num to become compressed.

The result can be a dif­fi­cult cycle. Eat­ing becomes uncom­fort­able, so patients eat less, lead­ing to addi­tion­al weight loss and fur­ther loss of the pro­tec­tive fat cushion.

To treat SMA syn­drome, Dr. Kudsi rec­om­mend­ed a robot­ic duo­de­no­je­junos­to­my. The pro­ce­dure cre­ates a new path­way for food to trav­el by con­nect­ing the duo­de­num to anoth­er sec­tion of the small intes­tine called the jejunum, allow­ing food to bypass the com­pressed portion.

Dr. Kudsi chose a robot­ic approach because of the tight, high­ly vas­cu­lar anato­my involved.

“The robot­ic sys­tem gives me a mag­ni­fied, 3D view of that tight anato­my,” he said, along with instru­ments that allow for more pre­cise sutur­ing in the con­fined space. The sys­tem also fil­ters out hand tremor, adding an extra mar­gin of safe­ty while work­ing near major blood vessels.

Com­pared with an open approach, robot­ic surgery can mean small­er inci­sions, less blood loss, less pain and a faster return to eat­ing and nor­mal activ­i­ty. For Krsti­na, that was espe­cial­ly impor­tant after months of pain and food intol­er­ance had left her nutri­tion­al­ly depleted.

Fac­ing surgery and want to under­stand your options? Learn more about robot­ic surgery at Duly, where our sur­geons take the time to walk you through every step, close to home. >

The surgery went well, and Krsti­na grad­u­al­ly began rein­tro­duc­ing foods into her diet. She spent a week on liq­uids before mov­ing to pureed foods, fol­low­ing Dr. Kudsi’s guid­ance on incor­po­rat­ing high-calo­rie foods at each stage of recov­ery. Since the surgery, she has gained weight and con­tin­ues to make steady progress.

A New Normal

See­ing the num­ber on the scale tick upward was­n’t the most pro­found shift Krsti­na noticed; it was what hap­pened the moment she fin­ished eating.

“For the first time in two years, I was able to go out to eat and then just resume nor­mal activ­i­ties right after. I just got in the car and left,” she said.

For most peo­ple, step­ping away from the table with­out a sec­ond thought is entire­ly ordi­nary. For Krsti­na, it was proof that her life was final­ly start­ing to feel nor­mal again.

Dr. Kudsi sees that trans­for­ma­tion first­hand, and it remains the dri­ving force behind his work with SMA syn­drome patients. ​“See­ing her go from years of not being able to eat nor­mal­ly to get­ting her life back is exact­ly why I find this work so reward­ing,” he said. ​“It’s a reminder that with the right diag­no­sis and the right sur­gi­cal cor­rec­tion, these patients can tru­ly get better.”

After near­ly two ago­niz­ing years of sec­ond-guess­ing every bite and brac­ing for the after­math, Krsti­na is wak­ing up to a real­i­ty she had almost giv­en up on.

“It’s a whole new world,” she said.

Your path to feel­ing bet­ter starts with a con­ver­sa­tion. If some­thing has­n’t felt right for a while, talk with a Duly provider about the next step that’s right for you. >