After emergency surgery to remove most of her esophagus, Monica Stark had no idea it would be nearly a year before she could eat solid foods. The lifesaving surgery, performed in April 2016 in San Antonio, resulted from complications caused by scleroderma, a rare connective tissue disease that affects approximately 300,000 Americans in very different ways.
In Monica’s case, she first experienced difficulty swallowing in 2010. Difficulty swallowing occurs because the tissues of the esophagus become less flexible, prohibiting normal muscle contractions that force food from the mouth to the stomach.
Over the next six years, Monica’s esophagus was stretched five times and four stents were placed in her esophagus to keep it open.
“The last stent rubbed a hole in my trachea,” said Monica. “That resulted in aspiration pneumonia. When I came out of the eight-hour emergency surgery, I had a hole in my neck with a bag attached to it, a PICC [peripherally inserted central catheter] tube pumping nutrition through a vein in my arm, and a g-tube [gastrostomy tube] that passed through my abdomen to deliver nutrition directly into my stomach.”
After a 20-day hospital stay, Monica went home to Tuleta, Texas, to recuperate. Her husband, James, diligently drained her feeding tubes, changed the bag that was glued to the front of her neck to capture saliva and any liquids she drank. Monica recalls it being a constant battle to keep the bag affixed, and her skin was always raw.
As spring turned to summer, Monica’s surgeon removed the PICC line that had provided intravenous nutrition; however, as summer turned to fall, Monica’s weight could reach no more than 110 pounds.
“None of the feeding formulas agreed with her,” said James. “We tried everything, but we couldn’t get Monica to the 120-pound mark set by the surgeon to reattach her esophagus. It was so frustrating not being able to help my wife.”
Struggling to eat, Monica fell into a depression. Medication helped, but food was everywhere, even on television. As 2016 drew to a close, 5-foot-5-inch Monica weighed just 94 pounds.
In mid-January, with her 55th birthday just days away, Monica was in total despair. “I was getting fearful for my life since I was coming up on one year without eating any food.”
Monica turned to the Internet to search for a thoracic surgeon who could reconstruct her esophagus. That’s when she discovered Farzaneh Banki, MD, director of the Esophageal Disease Center at Memorial Hermann Southeast Hospital and professor of surgery at the McGovern Medical School, part of UTHealth in Houston.
“There were a few thoracic surgeons who popped up, but when I saw Dr. Banki’s name I was instantly drawn to her,” recalled Monica. “There was something about her, her credentials and her work, and I wanted her to do my surgery.”
The next day Monica called Dr. Banki’s office. She received an appointment for the following week and had her medical records forwarded to Dr. Banki.
“As soon as Dr. Banki saw the bag on my neck, she said, ‘That’s no way to live your life. We have to get you fixed,’” explained Monica. “I started crying.”
Although Dr. Banki offered to perform the surgery to reconstruct Monica’s esophagus in just two days, the Starks requested more time to prepare. That is when Dr. Banki showed Monica and James her calendar and asked them to pick a surgery date. They selected a Monday in mid-February.
Before the surgery, Dr. Banki prepared the surgical team for what would be a 5-hour-20-minute procedure; substernal gastric pull-up
“Teamwork is very important for the patient‘s safety and wellbeing,” said Angela Kenerly, surgical technician, who sets up the operating room. “Dr. Banki is very thorough in preparing us.”
“It’s a collaborative effort,” said Nicole Tristan, RN, BSN, CNR, who meets patients before their surgery and oversees their care until they move to recovery. “Our team provides the whole continuum of care. Dr. Banki is a great surgeon and she has a wonderful bedside manner with her patients.”
During the substernal gastric pull-up surgery, Dr. Banki made a tube out of Monica’s stomach and pulled it behind her breastbone, then connected it to the remaining esophagus in her neck. Now Monica’s stomach is located in her chest cavity rather than her abdomen.
Later that week, Dr. Banki tested and confirmed there was no leakage in the reconstruction. She cleared Monica to start eating.
“On Friday morning, Dr. Banki told the nurses to give me a Popsicle®,” said Monica. “That was the first thing I had eaten that had gone down in a year. It was a big multi-colored Bomb Pop® and it was so good! I will never forget that day.”
Eight days later, Monica was ready to go home.
“One of the reasons Monica did so well and went home early was because of the specialized care provided at the Esophageal Disease Center at Memorial Hermann Southeast,” explained Dr. Banki. “This is not a procedure that can be done at any hospital. Our entire team has unique training in esophageal disease. From the surgical team to the nurses in the operating room, recovery room and bedside, everyone is trained to take care of this disease. If a patient has a problem, team members recognize immediately and communicate with us.”
Within a few weeks of returning home, Monica graduated from soft to solid foods. By early March 2017, she weighed 107 pounds. Three months after surgery, she weighed 115 pounds and was well on her way to her 130-pound goal weight.
During a reunion with her caregivers at the Esophageal Disease Center at Memorial Hermann Southeast, surgical technician Angela Kenerly was clearly emotional.
“I remember Mrs. Stark coming in and how frail she was,” said Angela. “It brought tears to my eyes today to see her with color, walking, smiling, and with more weight than when I saw her in the operating room.”
As Monica visited with her caregivers, she ate cake, drank punch and tried to reflect on her experience.
“It’s hard to put into words, but I had given up hope before I found Dr. Banki,” said Monica. "There’s a sense of isolation you feel when you can’t share a meal with people. Now that I can eat and join with others who are eating, I’m no longer on depression medication. Dr. Banki is 1000% devoted to her patients and her profession. What she and her staff did for me is absolutely amazing.”