John Kujac credits the specialists at The Iowa Clinic with bringing him back from the brink of death.
by The Iowa Clinic on Wednesday, July 29, 2015
Your Local Health | Written by BJ Towe
Few people come so close to death's door without actually walking through it. But after four episodes of mind-defying pain and uncontrollable vomiting—each one followed by a hospital stay—that's exactly where John Kujac was.
Kujac's third onset of intense, shoulders-to-lower-abdomen pain hit on June 26, 2014. Released from the hospital just days earlier, he was readmitted to the hospital with severe pancreatic necrosis, a condition in which inflammation causes a large amount of dead pancreas and fluid, which can block the stomach and cause liver enzymes to back up.
Removing the excessive fluid from his stomach was critical. After several unsuccessful attempts to insert a tube through his nose and into his stomach, through which the fluid could be removed, Kujac says, “I remember this doctor walking in with an entourage behind him. He said they had to get that tube inserted, and I believed him.” That doctor was Jeffrey Dietzenbach, M.D., a General Surgeon with The Iowa Clinic.
Convinced of the procedure's necessity, Kujac endured what he describes as pain so excruciating that he felt he was levitating off of the bed. “But I was so grateful that Dr. Dietzenbach had the strength and courage to do it,” Kujac says, adding that nearly four liters of fluid were removed from his body cavity.
On July 17, Kujac was released from the hospital.
Kujac Narrowly Escapes Death
Six days later, Kujac was back at Iowa Methodist, this time in very serious condition in the Critical Care Unit. He was in septic shock—the dead pancreas had become infected, causing it to affect other organs and his blood pressure to plummet.
“He came in with kidney failure and near respiratory failure. He was on a ventilator and underwent dialysis because his kidneys were shutting down,” Dietzenbach explains.
His condition was described to his wife as “very grave.”
Kujac's pancreas had ballooned from its typical six-inch size to the size of a football—and the sepsis had turned approximately 90 percent of it to mush. His pancreas needed to be removed, but he was too weak to survive such a difficult surgical procedure.
Pancreas is Removed Using Minimally Invasive Procedures
“Then a remarkable thing happened,” Kujac says. “Interventional Radiology became involved.”
Together, Dietzenbach and the Interventional Radiologists agreed upon a way to remove Kujac's pancreas using a minimally invasive procedure. Guided by fluoroscopic imaging and X-ray, they inserted a small grinder—a bit like an egg beater—through a tube in Kujac's side to grind up and flush out the pulp.
“They did this three days a week for several weeks. Finally, the dead pancreas was gone; it was like magic,” Kujac says.
Improved, But Not Home Free
The Iowa Clinic's critical care team helped get him through the acute stage of the sepsis and renal failure. Nutritionists monitored his nutritional intake, which was delivered by feeding tube. Seemingly, a legion of specialists became involved over the course of three months.
“His kidneys came back, his lungs recovered, and his nutrition improved,” says Dietzenbach.
However, the necrotic material surrounding his pancreas had burrowed a hole into the side of Kujac's duodenum, which is the part of the intestine immediately beyond the stomach. That hole continued to allow gastric juices to spill over into the abdominal cavity. “It was feeding his dead pancreas. Surgery was essential to prevent ongoing infection,” Dietzenbach says.
In an uncommon operation, the duodenum was bypassed. “Basically, we stapled across part of his stomach and brought part of his intestine up to create an alternate route for food. This allowed him to eat again,” Dietzenbach says.
Ten days later—after 154 total days in the hospital—Kujac was able to return home. This time, it was for good.
It Took a (Medical) Village
“What do you say about a group of people that saved your life? They're your heroes,” Kujac says.
“You think from TV and the movies that there's just one doctor that does it all. Dr. Dietzenbach was clearly the leader—and I cannot say enough about my high esteem for him—but there were so many people involved,” Kujac says. “For example, the doctors in Interventional Radiology were the ones that took out my pancreas a straw-full at a time.”
Dietzenbach says, “Doing the right interventions at the right time made the difference. From start to finish, it was a team effort.”
Enjoying Life Again
“There was a point that most people thought John wouldn't live through this without having major long-term issues, such as kidney disease or needing nursing home care,” says Dietzenbach. “He probably should have died from this condition. He not only survived but is now living a very fulfilling life.”
Before becoming ill, Kujac weighed 285 pounds. He lost 110 pounds in the hospital and has stabilized there. Today, he has a new appreciation for his health and his life.
He adds, “My energy is increasing, my strength is increasing, and my ambition to do things—that frankly I never thought I'd be able to do again—is increasing.
“It's a new era. There are new normals. I probably came as close to the edge of eternity as anyone I've ever known, and still clawed my way back. I'm happy to be alive.”
The Care Team
Dozens of medical professionals contributed to John Kujac's life-saving care. Among them:
The Iowa Clinic Critical Care Department
The Iowa Clinic Physical Therapy Department
- Mallory Swenson, PT, DPT
- Iowa Methodist Interventional Radiologists
- Iowa Methodist Nephrologists
- Iowa Methodist Nutrition Centre Dietitians