November 2015
     EXPERIENCE COUNTS
  
  
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.
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 many 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 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.
 
SUMMARY: 
 
As you can see from this case study, experience really counts when confronting complex healthcare problems. 
TO START THE CONVERSATION:                                              

1-800-620-7551 or 647-350-5500

 

Email us at: info@rupertcasemanagement.com

 

It all starts with a conversation.  We are always pleased to help.

 

 

           Raymond Rupert MD. MBA.
           Founder/Medical Director
           Rupert Case Management Inc.
           505 Eglinton Avenue West, Suite 203
           Toronto, ON M5N 1B1
           direct:     647-350-5500
           24*7:       1-800-620-7551
           email: info@rupertcasemanagement.com
           www.rupertcasemanagement.com 
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