For years, Kevin Roy battled severe stomach pain and cramping. When he was finally diagnosed with diverticulitis in late 2014, he and his doctor hoped that antibiotic therapy would calm the turbulence in Roy's intestines.
For Roy, the fever, nausea, vomiting, chills and other symptoms eventually became so challenging, his gastroenterologist referred him to the UCI Health H.H. Chao Comprehensive Digestive Disease Center (CDDC) for treatment.
Diverticulosis vs. diverticulitis
According to the National Institute of Diabetes and Digestive and Kidney Diseases, about half of people age 60 and older have diverticulosis, a condition in which small pouches form in the colon. Most people with this mild condition don't have any symptoms or have only occasional cramps, bloating and constipation. Increasing dietary fiber often resolves the symptoms.
But in other cases, like Roy’s, the pouches became inflamed or infected, a condition known as diverticulitis. Severe cases can not only cause pain and extreme discomfort, but also lead to bleeding, perforation or blockage of the colon.
"Doctors are very successful in treating uncomplicated diverticulitis with antibiotics. But complicated cases almost always require surgery," says Dr. Joseph Carmichael, a UCI Health colon and rectal surgeon. "We see a lot of the more complicated cases at the CDDC because these cases are referred to us."
The CDDC is especially adept at tackling complex cases because its surgeons and gastroenterologists are highly specialized and, as part of an academic medical center, are trained in the latest treatments and techniques.
Complex cases need specialized care
Today, Roy, 47, is grateful he sought treatment at the CDDC. When the Claremont man, who works as an electrician on locomotives, was first diagnosed with diverticulitis, he initially felt some relief after taking antibiotics. But in early 2015, the condition flared up. His abdomen swelled and he became feverish, and once he even rushed to the emergency room of his community hospital for help.
"They said I just had to manage it, which was becoming more and more difficult to do," Roy says. "I was on a liquid diet at one point and feeling pretty terrible." When his symptoms worsened, his local doctor referred him to UCI Health.
"The gastroenterologist said this was ‘a unique and tricky’ case but that the UCI Health digestive disease center was the best in the area, and he felt I would have better results there."
Roy says he was "in panic mode" at first. He had heard horror stories of surgery resulting in Frankenstein-like scars, difficult recoveries and long-term digestive problems.
But Carmichael immediately put Roy at ease.
"He said my case was different, but he had seen and dealt with similar cases before and was comfortable with the procedure," Roy recalls. "He was interested in what I did with the railroad.”
Minimally invasive surgery
In September, Carmichael performed minimally invasive surgery on Roy to remove two sections of bowel, including removal of a fistula, which is an abnormal, tubelike connection that forms between two organs — in Roy's case, the large intestine and the bladder. The surgery resulted in only a few small scars instead of a large incision and the need for a colostomy.
When the large intestine has become connected to the bladder through a fistula, patients at many hospitals usually undergo an open operation with large incisions and possibly a temporary ostomy bag, Carmichael says. But at the CDDC, "laparoscopic surgery is our default approach.” With laparoscopy, surgeons operate using instruments and cameras inserted through tiny incisions.
“About half of hospitals never try it, however, and in tough cases even fewer would try it,” he says. “But we were able to handle Kevin's case laparoscopically. We get tough cases, but we're well practiced at it."
UCI Health ranks in the upper 10 percent of hospitals nationwide on colorectal resection results, based on surgical quality performance data.
Carmichael says patients with complicated cases like Roy’s should seek treatment at a specialized center or see a specialist in colorectal surgery who has received advanced training through a fellowship.
Recovery, work and pizza
Roy spent five days in the hospital and recovered without any setbacks.
“The CDDC was wonderful and comfortable," Roy says, adding that a nurse navigator even helped him file complicated paperwork for disability.
He returned to work after six weeks and made a long-scheduled trip to New York City with his wife, Cari, to celebrate their anniversary.
"I wanted to recover in time for that trip so I could eat when I got there. I ate greasy pizza every single day," he says, with a laugh. "I feel more normal than I have in years. You don't know what kind of discomfort and pain you're in until it's gone."
Some patients don't realize that appropriate treatment — even surgery in some cases — will end their misery, Carmichael says.
"For a lot of these patients, they are fighting this chronic, smoldering infection," he says. "They are like a boat pulling an anchor. After they undergo this treatment, we see them get their lives back. They get more energy. It's fun to see people get all that back."