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Able to Eat Again!

Read how a misdiagnosis left Christine Spence unable to eat real food for years – until she talked with her physician at The Iowa Clinic.


Able to Eat Again

Misdiagnosis

More than a decade ago, Christine Spence, 56, of Lacona was diagnosed with heartburn, also called acid reflux disease. Although she took medication, the condition steadily worsened. About six years ago, she began having trouble keeping food down.

“My doctor sent me to a specialist in Des Moines, who diagnosed me with gastroparesis,” Spence says. Gastroparesis is a condition that affects the stomach muscles and doesn’t allow the stomach to empty properly. Spence was prescribed a diet of soft foods.

But the vomiting worsened. “About once a month, I was sick. Then twice a month. Then once a week. About four years ago it got bad enough I was almost afraid to eat – just a few bites and I’d be sick,” she says. “If I did eat, I could be in the bathroom throwing up for six hours.”

Spence saw more doctors and specialists, and even found herself in an emergency room. At one point, she was diagnosed with a slight hiatal hernia, in which a portion of the stomach pushes upward through the diaphragm. She was told that, as with most hiatal hernias, it was nothing to worry about.

“I told all of those doctors that I’d been diagnosed with gastroparesis. No one ever questioned it, so I thought I’d just have to live like this,” she says.

Spence resigned herself to a diet of nutritional drinks, ice cream, and pudding. Her weight dropped nearly 40 pounds. Her hair began to fall out. Eventually, it also became difficult to breathe.

SISTER URGES SPENCE TO SEE ANOTHER DOCTOR

When her sister visited in December 2014, she witnessed one of Spence’s post-eating episodes. “It went on for hours,” Spence says.

“She and my husband said I had to find (a different doctor). I promised them I would talk with Dr. Johnson at the first of the year,” she says. Yulia Johnson, D.O., is Spence’s Family Medicine physician at The Iowa Clinic, whom Spence had seen for minor problems but never told about her stomach issues.

Dr. Johnson says, “She came in on January 22nd, said she vomited after every meal, and that she had been diagnosed with gastroparesis. Gastroparesis typically occurs in patients with diabetes, which Christine does not have. She’s a relatively healthy woman with no chronic conditions.”

Johnson probed and learned that the “gold standard” medical test for diagnosing gastroparesis had never been done for Spence. Additionally, Johnson says, “There are many other conditions that could cause Christine’s symptoms. I ordered a battery of new tests.”

STUNNING TEST RESULTS

Among Spence’s tests was an upper GI, which allowed Joshua Rosebrook, M.D., a Radiologist in The Iowa Clinic’s Medical Imaging department, to watch on a video screen how a barium solution moved through her esophagus, stomach, and first part of the small intestine. Spence hadn’t yet completed the test on January 26 when Johnson got the call from Dr. Rosebrook.

Rosebrook explained that Spence had a huge hiatal hernia – 80 percent of her stomach was in her chest cavity.

Spence says, “My stomach was pressing against my lungs,” which is why she was having trouble breathing.

RESOLUTION COMES QUICKLY

With the right diagnosis in hand, The Iowa Clinic physicians and surgeons moved swiftly. In fact, on the same day as her upper GI test, Spence saw Gastroenterologist Joel Hade, M.D., and General Surgeon Jeffrey Dietzenbach, M.D. On February 10, 2015, she had surgery to repair the hernia.

Dr. Dietzenbach says waiting any longer for corrective surgery could have presented even more serious health risks: In addition to other organs potentially migrating into her chest cavity, “When the stomach has slipped up into the chest, it can twist, which can result in the lack of blood supply to the stomach. If the stomach dies, that can be a fatal problem,” he says.

Using laparoscopic surgery, which involves only small abdominal incisions and reduces the patient’s recovery time, Dietzenbach moved Spence’s stomach back down through the diaphragm and to its natural position and closed the hole in her diaphragm.

Spence’s ability to eat solid food was immediately restored.

“I have told Dr. Johnson over and over she’s been my savior through this. And Dr. Dietzenbach didn’t look at me and say, ‘This is what you were diagnosed with and that’s the way it is’ – he said we’d get to the bottom of it,” Spence says.

As the result, “I have a quality of life I never expected to have again,” Spence adds. “The steak I had after surgery was one of the best things I’ve ever eaten.”

IF YOU’VE BEEN DIAGNOSED WITH A HIATAL HERNIA

Hiatal hernias are common, affecting up to 60 percent of the population by age 60. Most hiatal hernias are harmless and do not require treatment, but they can worsen over time.

Jeffrey Dietzenbach, M.D., a General Surgeon with The Iowa Clinic, advises patients to be aware of their symptoms and, if they worsen, talk with their doctor about the possible need for follow-up tests.

“If we can repair a large hiatal hernia early, the surgery is easier to accomplish and has less risk for the patient,” Dr. Dietzenbach says.

“Conversely, if a hiatal hernia is allowed to progress to advanced stages, it requires a more demanding surgery, a longer recovery, and can be associated with a higher rate of complications,” he says.

There are many conditions that can cause heartburn, chest pain or burning, stomach pain, nausea, diarrhea, or vomiting. If any of these symptoms becomes severe or frequent, see your primary care physician right away. Or call The Iowa Clinic at 515-875-9000.

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