A search for a diagnosis and surgery that offered hope
Natalie Morse of Marstons Mills has one goal for Christmas Day this year: To eat at least part of a cheeseburger with all the toppings. And because of a surgical procedure performed by Falmouth Hospital surgeon, Peter Hopewood, MD, that she didn’t think was possible, her wish will come true.
Morse has traveled a winding road over the past five years. Bouts of severe abdominal pain with nausea and vomiting landed her in the emergency room at least once a month over that time. She was eating less and less because the pain was so bad when she did try to eat.
In 2012, the situation became so bad that she needed a feeding tube. A feeding tube inserted through her abdomen into the second segment of her intestine, enabled her to receive fluid nourishment.
“I haven’t been able to eat in four years,” said Morse, earlier this year. Her “meals” consist of one and a half quarts of formula. “I have to hook up to a liquid feeding pump that is connected to my feeding tube for 15 hours every night.”
Doctors told Morse she was suffering from gastroparesis, a condition that slows the movement of food from the stomach to the small intestine. Normally, the vagus nerve, which is one of the nerves that originates in the brain, stimulates muscles in the stomach to break up the food and move it through the intestines. When that doesn’t happen, it can cause severe stomach pain, nausea, vomiting, bloating and lack of appetite.
While Morse had a diagnosis and the feeding tube, she continued to have symptoms and more weight loss. She was determined to find out why she was not getting any better.
In 2013, she was diagnosed with a rare digestive disorder, Superior Mesenteric Artery Syndrome (SMAS, SMA), also known as Wilke’s syndrome, by Brian Lacy, MD a gastroenterologist at Dartmouth-Hitchcock Hospital in New Hampshire. The syndrome tends to affect young females between 17 and 39 years old and is only seen in 0.013 percent to 0.78 percent of the general population according to the Annals of Gastroenterology.
SMAS occurs when the duodenum (the first segment of the intestine) becomes compressed between two arteries, the superior mesenteric and the aorta. With rapid weight loss, the fat that separates those two arteries is lost, causing partial or complete blockage of the intestine. This causes intermittent, severe abdominal pain, nausea and vomiting.
Dr. Lacey and Morse had discussed the possibility of surgery on and off over the past three years.
“My husband and I went to Boston for some consultations, but the surgeons wouldn’t touch me because they thought I wouldn’t survive the surgery,” said Morse. “We had given up hope of any type of surgery or me ever eating again.”
But one day last year her feeding tube fell out and she went to the Yawkey Emergency Center at Falmouth Hospital to have it replaced.
“They all know me there and know my case because I go at least once a month,” said Morse.
Dr. Hopewood was on call and met Morse for the first time. After learning of her condition, he thought he could help.
“With SMA syndrome, the two arteries work like a pincher movement,” said Dr. Hopewood. “The artery pinches off the duodenum just below the stomach and then the stomach works so hard to get food past that area that it develops muscle fatigue and ends up being a weak stomach.”
Treatment typically involves trying to get a patient to gain some weight in order to add fat in between that space and the duodenum will then open up and lift the artery out of the way, said Dr. Hopewood. In Morse’s case, she would gain a little weight, but not enough to make a difference, he said.
The Prospect of Surgery – And Hope
Dr. Hopewood offered to do surgery that would bypass the constricted area of the duodenum so that Morse could eat again. She almost couldn’t believe what she was hearing.
“It was the most incredible thing, Rick (her husband) and I just looked at each other,” she said. “There is a surgeon who was willing to do the surgery for us on Cape Cod.”
Dr. Hopewood consulted with Morse’s gastroenterologist, Dr. Lacy, and he agreed that Dr. Hopewood would go ahead with the surgery.
On May 12, 2016, she was admitted to Falmouth Hospital and had a duodenojejunostomy, a surgical procedure to sew a piece of the jejunum (middle segment of the small intestine) to the duodenum to create an opening and bypass the obstruction. She spent 20 days in the hospital.
When she was ready to try eating her first meal, it was a popsicle and Jello.
She has since been able to eat small amounts of granola, soups and pudding, as well as yogurt, raisins and different types of trail mixes throughout the day.
“Dr. Hopewood was a God send,” said Morse. “People have no idea that our Falmouth Hospital can provide so much for us.”
Dr. Hopewood’s advice to people with hard-to-treat illnesses is don’t despair.
“Don’t lose hope. Say ‘ok, I’ve had enough done for now but can I come back again in six months or a year and see if things have changed or if there are any new advancements or developments that have occurred in medicine or surgery.’
“Sometimes there are fixes, it’s a risk versus benefit. Natalie had reached a point where the benefit of the surgery was more than the risk.”
Morse’s medical journey may not be over yet. She is meeting with Dr. Lacy at Dartmouth-Hitchcock soon to see whether a pacemaker will help stimulate her stomach muscles to move the food along.