Innovative Bowel Lengthening Surgeries Give Saudi Patient New Lease On Life
Cleveland Clinic surgeon performs dual procedure for the third time in the world
On what seemed like a typical day in January 2010 for 55-year-old Zakiyah Al-Shakis of Dhahran, Saudi Arabia, she and her husband had friends over for dinner at their home. But then everything changed. Mrs. Al-Shakis went to the bedroom to change her clothes after their guests left, and she felt an intense pain in the bowel area. She became unconscious and was rushed to a nearby hospital.
It turned out that Mrs. Al-Shakis had a medical condition that caused a blood clot that resulted in the loss of a major portion of her small intestine. Doctors initially told her family that she only had a few hours to live and advised them to say their goodbyes. However, her family refused to accept that prognosis, her son Ali M. Aljelwah says. Her condition remained critical, but day by day, she grew a bit stronger.
Once Mrs. Al-Shakis’ condition was stable, her family transferred her to a referral hospital in Dhahran, where the surgeon told the family that her best odds for recovery would be to consider a small bowel transplant. Since the surgeon knew of no hospital in the Middle East with the equipment or expertise to perform the procedure, the family took her to the United States to see Kareem Abu-Elmagd, MD, PhD, who was in Pittsburgh, Pennsylvania, at the time and has since been named Director of Cleveland Clinic’s Transplant Center and of the Center for Gut Rehabilitation & Transplantation.
“My brother researched the best surgeons in the United States for small intestine transplants, and that’s how we found Dr. Abu-Elmagd,” Mr. Aljelwah says.
Nothing better than your own gut’
When Mrs. Al-Shakis and her family went to see Dr. Abu-Elmagd, he delivered some unexpected news. He told them about a novel bowel lengthening procedure that could potentially avoid the need for a small bowel transplant, thereby eliminating the risk of rejection and the need for anti-rejection medications as well as related issues with immune system suppression and possible infection.
“Nothing is better than your own gut,” Dr. Abu-Elmagd says. “I told them that we could attempt to lengthen the remaining small bowel, and if there wasn’t enough intestine or if it later failed, we could still consider a transplant later on down the road.”
The surgery was based on a newer procedure performed primarily in patients with short bowel syndrome called serial transverse enteroplasty (STEP), in which the bowel is cut and stapled into v-shapes on alternating sides to decrease its width and increase its length. Surgeons believe that the zigzag pattern allows more time for nutrients to be absorbed as food passes through the intestines.
The surgery was a success and Dr. Abu-Elmagd was able to lengthen Mrs. Al Shakis’ bowel by 60 cm. She was able to start getting nutrition from food she ate rather than subsisting on total parenteral nutrition (TPN) and no longer needed to have a colostomy bag. In addition to anticoagulant therapy, she was prescribed constipators. However, following the first procedure, she still frequently had diarrhea and lost a significant amount of weight and was down to 50 kg, which is not unusual in patients with this condition.
“She is very active and is always out shopping or running other errands,” Mr. Aljelwah says. “She enjoyed being able to eat food again, but the chronic diarrhea was inconvenient.”
Second procedure breaks new ground
When Mrs. Al-Shakis went to see Dr. Abu-Elmagd earlier this year at Cleveland Clinic for what she thought would be a routine check-up, he delivered some exciting news. He told her that her intestine actually had widened, and that he thought they might be able to stretch it out some more to gain some additional length.
What was even more exciting was that this was to be only the third time in history to perform a second bowel-lengthening procedure in a patient. “We knew that we were in good hands with Dr. Abu-Elmagd,” Mr. Aljelwah says.
The surgery was a success and the bowel was lengthened by an additional 15 cm.
Just a few weeks after the surgery, while at Cleveland Clinic for a check-up, Mrs. Al-Shakis was about “70 percent back to normal,” according to Mr. Aljelwah, and they expected that percentage would continue to increase as she fully recovered from surgery.
“I’m more active now and feel much better,” Mrs. Al-Shakis says. “I have a better quality of life being able to eat regular food, too.” Mrs. Al-Shakis spent much of her career in a government job, where she focused on finding homes and getting treatment for orphaned, disabled children. She has written a book on helping children with disabilities and says that part of what helped her with her recovery was journaling, “in a hopeful kind of way, not a painful way.”
Global Patient Services concierge service
When Dr. Abu-Elmagd moved to Cleveland Clinic, Mrs. Al-Shakis and her family also began to benefit from the concierge services provided by the health system’s Global Patient Services (GPS) team. At a post-operative appointment a few weeks after surgery, two of GPS’s bilingual staff members spoke with Mrs. Al-Shakis and Mr. Aljelwah, answering their questions and giving them advice about their upcoming trip home.
“The GPS staff have been extremely helpful,” Mr. Aljelwah says. “They arranged all of our appointments, showed us around, and even assisted us with our hotel reservations and had a car at the airport to pick us up. This was especially appreciated when we had so many other details to focus on.”
Contacting Global Patient Services
If you are considering a visit to Cleveland Clinic, you can reach GPS at +001.216.444.6404.
International Patient Experience Conference in Saudi Arabia focuses on ‘Patients First’
Cleveland Clinic’s Office of Patient Experience presented the 2nd International Patient Experience Conference earlier this year in Yanbu, Saudi Arabia, which brought together more than 350 medical leaders and caregivers from across the world who addressed the importance of delivering exceptional clinical outcomes and patient-oriented care in the most efficient, effective manner. The conference was organized under the patronage of His Excellency, Dr. Abdullah Bin Abdul Aziz Al-Rabeeah, the Saudi Minister of Health.
The event was the first one organized by Cleveland Clinic's Global Solutions' Riyadh Office, underscoring our commitment to both medical professionals and patients in the region. The focus on patient experience is an outgrowth of Cleveland Clinic’s approach to “Patients First” that embodies high-quality, innovative and compassionate care. In addition to providing training and education and clinical programs for healthcare providers and institutions in the region, the Riyadh Office offers streamlined access and facilitated services for patients wishing to be treated at Cleveland Clinic.
Thought leaders from various disciplines in healthcare, government and business met to discuss and solve shared challenges and inspire solutions to transform the patient experience and elevate customer service. The conference defined the patient experience and its critical link to patient relations and how quality care is delivered. Conference speakers focused on how healthcare workers can improve the way they communicate with patients and families, with an emphasis on physician-patient and nurse-patient communication.
Featured speakers included Dr. James Merlino, Chief Experience Officer, Cleveland Clinic; Dr. Marc Harrison, Chief Executive Officer, Cleveland Clinic Abu Dhabi; and Dr. Mohammed Zamakshary, Assistant Deputy for Planning and Education at the Saudi Ministry of Health. Cleveland Clinic was one of the first major academic medical centers in the country to establish an Office of Patient Experience and appoint a Chief Experience Officer, as well as the first major academic medical center to host a summit focused solely on patient experience.
“Cleveland Clinic is thrilled at the opportunity to share globally the knowledge we have gained from our own initiatives in the patient experience arena,” Dr. Merlino says. “This conference will help ensure that compassion, empathy and responsiveness continue to be at the forefront of healthcare delivery in Saudi Arabia.”
The complete International Patient Experience Conference agenda can be found online at www.patientexperienceksa.com.
Commitment to the region
The conference was organized in partnership with the Kingdom of Saudi Arabia’s Ministry of Health, Directorate of the Health Affairs in Madinah Region, Healthcare Development Holding Company, and Cleveland Clinic.
Cleveland Clinic has had a relationship with the Kingdom of Saudi Arabia for more than 40 years. In addition to the outreach office which opened in Riyadh in 2012, our Global Patient Services office in Cleveland, Ohio, USA, can help facilitate visits to Cleveland Clinic via phone or email.
“The Saudi Patient Experience Conference was a wonderful example of the broad reach of Cleveland Clinic and its values extending to other cultures across the globe,” says James Benedict, JD, Executive Director, Cleveland Clinic Office of Professional Staff Affairs.
Spotlight: Cole Eye Institute
Thousands of international patients travel to Cleveland Clinic's Cole Eye Institute each year. In fact, last year, patients traveled from an estimated 34 countries to receive world-class care from our specialists. Cole Eye Institute is one of the newest and most state-of-the-art institutes in the United States, handling more than 140,000 national and international patient visits per year.
In 2013, our institute was ranked No. 7 and among the top hospitals in the United States for eye care in U.S. News & World Report’s prestigious national hospital survey. Many procedures developed here have been adopted by ophthalmologists around the world, and the institute offers the largest hospital-based continuing medical education program in the United States.
The institute’s ophthalmologists, surgeons and other caregivers treat adults and children with all ophthalmic conditions, from the routine to the complex. They are guided by Cleveland Clinic’s focus on “Patients First,” which means top quality patient care, comfort and convenience. The institute specializes in a range of options—including high-tech surgery— for treating eye diseases such as retina disease, diabetic retinopathy and many others. In addition, a large team of researchers is committed to making breakthroughs in key areas of eye health such as retinal disease.
Eye surgery at Cole Eye Institute— ranging from cataract surgery to macular surgery — is performed daily by some of the world’s leading experts. The surgical facility is designed to have all preoperative testing in one location. The five operating rooms incorporate the latest equipment to perform eye surgery safely and effectively. A special waiting area lets family members talk to the surgeon in a private setting after the eye surgery.
Spotlight on retinal disease
Most people never give their eyes — let alone their retinas — a second thought until something goes wrong. Yet, retinal diseases are one of the leading causes of blindness in adults. Your retina is the light-sensitive lining in the back of your eye. It contains millions of special nerve cells that react to light. These photoreceptors send electrical impulses to your optic nerve, which your brain converts into the images you see.
At Cleveland Clinic’s Cole Eye Institute, retina specialists have the expertise to accurately diagnose and offer world-class treatment for retinal diseases, including age-related macular degeneration, diabetic retinopathy, retinal detachment as well as more uncommon conditions such as retinal inflammatory disease.
New surgical procedures developed by the Cole Eye Institute team are now used worldwide for people suffering from diseases such as retinal detachment, diabetic macular edema, diabetic traction detachments, macular holes and retinopathy of prematurity. Team members also have helped develop the next generation of medications, laser treatment, imaging and vitreoretinal surgical devices.
Seeking treatment as soon as possible is often critical when it comes to many retinal diseases. In many cases, early diagnosis and treatment can help stop vision loss.
Scheduling an appointment
To schedule an appointment at Cleveland Clinic’s Cole Eye Institute in Cleveland, Ohio, USA, please do one of the following:
- Contact the Global Patient Services Patient Access Office at 216.444.8184. (Contact your international operator to determine the dialing prefixes for calling the United States from your country.)
- Make an online appointment request by completing the Online Appointment Request.
Mobile apps keep you connected to Cleveland Clinic
Even if you are thousands of miles away from Cleveland Clinic, you can stay connected every day by downloading our free mobile applications, or apps, for iPhones, iPads and Android phones and tablets. The apps, which all have a focus on wellness, are designed to make your life better, easier and healthier.
The apps, which you can quickly and easily download through your mobile device provider’s app store, include:
- Cleveland Clinic Today App, available for the iPad: This is your daily interactive source for the latest health and wellness tips from the experts at Cleveland Clinic, which once again this year was named one of the United States’ Top 4 Hospitals in the U.S. News & World Report’s 2013-14 Best Hospitals’ Rankings.
- New content is added to the app on a daily basis, including:
- Health & Wellness Tips
- Healthy Recipes
- Health Quizzes
- Health & Wellness Videos
Other features include:
- Rate and save articles to your Favorites
- Share articles via Email, Facebook, and Twitter
- An interactive 3D model of the human body that is fully rotatable and zoomable
- Access expert insight from Cleveland Clinic doctors on Health Hub, which includes blogs, videos, Web chats and more
You can also:
- Request an Appointment
- Find a Doctor
- Contact Us
- Access MyChart — mobile access to your electronic medical records (for current patients)
- MyChart App, available for the iPhone and Android phones: Are you a Cleveland Clinic patient who would like to view test results, medications, doctor’s appointments and more on your mobile phone? If you are a MyChart user, you already have secure, online access to your health information. The MyChart app allows you to receive this information on your phone.
- Let's Move It App, available for the iPhone and Android phones: Your mobile path to a healthier lifestyle can start with walking or running, simple, effective ways to improve health. The Let’s Move It app makes walking and running fun and goal-oriented. Select among 15 walking “challenges.” Track your progress with the free pedometer feature. Access Cleveland Clinic exercise videos and information, a calorie converter and weekly wellness tips.
- Wellness Tip of the Day App, available for the iPhone: This app provides convenient, short, daily health- and diet-related tips from Cleveland Clinic experts in two formats: colorful bouncing balls, each displaying a wellness tip; or a calendar-style offering of daily tips. It’s easy to share these tips on Facebook or to email them to others.
- Go! To Sleep App, available for the iPhone: Are you getting enough sleep? Lack of sleep can affect your success in life — whether it’s school, work, personal relationships, health or safety. Untreated sleep problems can even cause high blood pressure, heart disease and stroke. Improve your sleep habits with Go! To Sleep, a unique app that assigns you a “sleep score,” rating the quality of your sleep.
Survey questions relate to caffeine, alcohol, exercise and relaxation. Your answers are weighted by importance to create an overall score based on your lifestyle and morning and nighttime behaviors.
The app includes a timer to keep track of your sleep and to record interrupted sleep. If you upgrade, you can see past results, chart progress and receive daily sleep tips.
- Heart Story App, available for the iPad: A Day in the Life at America’s No. 1-Ranked Heart Program. Science and sensitivity come together in this thought-provoking interactive newspaper series documenting 26 hours behind-the-scenes of the Cleveland Clinic Heart & Vascular Institute. Get a first-hand look at patients and families who travel to Cleveland, Ohio, USA, for treatment, their compassionate caregivers, and some the most skilled cardiologists and cardiothoracic surgeons in the world. Explore how hearts are transplanted, valves fixed and lives saved.
For access to a number of other free apps, check your provider’s app store under Cleveland Clinic and/or Cleveland Clinic’s website, which also includes links to the app stores. Our development team is always working to develop new apps and updates, so be sure to check back often.
“We are constantly striving to develop leading-edge technology solutions,” says Tony Crimaldi, Mobile Marketing Manager for Cleveland Clinic. “As we develop and release mobile applications, we gather user feedback, monitor technology upgrades, and provide new development updates.”
If you use your mobile device to access Facebook, don’t forget to “Like” Cleveland Clinic and Cleveland Clinic Children's so that you receive the latest news, updates and health tips for you and your family directly to your Facebook newsfeed.
Recipe Corner: Herb-Friendly Lentil Salad
This Mediterranean dish is packed with protein and other nutrients from legumes and vegetables. It’s also chock full of herbs.