As part of its Inflammatory Bowel Disease Center of Excellence, AdventHealth Orlando has assembled a multidisciplinary team of experts to care for patients suffering from intestinal failure under the leadership of board-certified colorectal surgeon John Monson, MD.
A condition in which the body’s gastrointestinal system is unable to absorb necessary fluids, nutrients, and electrolytes. Intestinal failure is a potentially fatal diagnosis and is a serious complication of other gastrointestinal diseases such as inflammatory bowel disease, Crohn’s disease, ulcerative colitis, and gastrointestinal disorders. Bowel syndrome and intestinal motility disorders. It is often caused by a previous failed colorectal surgery. Patients suffering from intestinal failure require intravenous (IV) feeding or supplementation. Although a relatively rare condition, intestinal failure has significant negative economic and patient quality of life consequences.
Care of patients with fatal intestinal failure
In the most dire cases of intestinal failure, patients endured multiple surgeries (sometimes as many as 50) with negative results. They develop enterocutaneous fistulas, which are abnormal connections between the intestinal tract or stomach and the skin. These fistulas most often occur after intestinal surgery, where stomach or intestinal contents leak into the skin. Many of these patients also have complex wounds. They become dependent on total parenteral nutrition (TPN) and must receive all their nutrition through an IV drip.
The complex challenges of fistulas, wounds, and TPN can leave patients with catastrophic intestinal failure confined to their homes, bedridden, or even hospitalized for months at a time. As a result, many people become socially isolated and unable to work or participate in most activities of daily life. Many of these patients are young and feel as though their lives are ruined with no hope of improvement.
“These patients are some of the most critically ill patients, and they just want their lives back,” Monson explains. “Their cases are so complex that no one wants to take them on. We have assembled a small but dedicated multidisciplinary team of experienced physicians and health care providers. The focus is on slowly guiding them toward their next surgery and ensuring that this resolves their nightmares of the past months or years. A one-size-fits-all approach to caring for these patients There is no single approach. Each has its own challenges and requires its own solutions.”
approach
AdventHealth’s multidisciplinary team for patients with intestinal failure includes:
- gastroenterologist
- colorectal surgeon
- Specialist nurses, including wound care and stoma nurses
- nutritionist
- Analgesic specialist
- psychologist
The team meets regularly to collaborate and discuss each case to achieve the best outcome.
Patients with intestinal failure are desperate for answers and solutions, but there are no quick fixes. When a patient with intestinal failure first comes to her AdventHealth, the care team conducts a thorough evaluation and creates a long-term, customized care plan that lasts two to three years. Most patients with intestinal failure require surgery, but it is not the first step. Because these patients have had so many surgeries before, their first six months to a year are spent allowing their bodies to heal so that when they do the surgery again, the surgery will be successful. The emphasis is on
“We call this a time-out,” Dr. Monson explains. “This story may come as a shock at first, as patients were anxious to move on, but we are committed to protecting their health and helping them get their lives back.” I guarantee you that.”
During this period, the focus is on maintaining proper nutrition, preventing infection, and helping the patient regain strength before the next surgery.
“When we do revision surgery, we want to do it right the first time,” says Dr. Monson. “From day one, we told them we would do whatever it took to help them. The losses stop here and no one on this team is giving up on them.”
The team also strives to develop close relationships with patients, their families, and caregivers, ensuring that they understand that they are the most important members of the team.
professional care
Caring for patients with intestinal failure includes not only maintaining proper nutrition and managing the underlying disease that caused the intestinal failure, but also managing and preventing additional complications such as fistulas and stomas/stomas. Is required.
A fistula occurs when an abnormal connection forms between part of the gastrointestinal tract and the skin or other organ, allowing stomach acid to leak. There are many different types, including colocutaneous fistulas, enteroatmospheric fistulas, enterocutaneous fistulas, and intestinal fistulas. These can be caused by surgery, infection, or inflammatory bowel diseases such as Crohn’s disease.
“For patients with intestinal failure, managing these complex wounds can be one of the most frustrating and distressing tasks,” explains Dr. Monson. “We have specialized nurses who help regain control in patients with intestinal failure, both inpatient and outpatient.”
Teresa Pineda, BSN, RN, CWOCN, a wound, ostomy, and continence (WOC) nurse, works closely with Dr. Monzon at AdventHealth, where she cares for patients with intestinal failure in both inpatient and outpatient settings. Specialist member of a multidisciplinary team. Like fistula care, stoma care also creates long-term challenges for these patients. A stoma is a surgically created opening in the body to allow stool to pass from the intestines. Pineda provides customized, complex stoma care and education to help patients regain independence and prevent hospital readmissions.
“We don’t want anyone to be hospitalized or debilitated,” Pineda explains. “Our goal is always to provide them with timely care and support so they can return to their families, communities and their lives. We work with each intestinal failure patient to , based on each specific symptom and situation, we devise a pouching strategy that works for that patient. Then we fine-tune it until we get it right.”
Additionally, if patients do not wish to undergo surgery, the AdventHealth team also provides access to promising new treatments through numerous clinical trials.
whole person care
The Intestinal Failure Care Team is passionate about AdventHealth’s mission of making patients healthy again in body, mind and spirit.
“There’s no question that these are very complex and difficult patients,” Pineda explains. “But no matter how challenging they may be in our eyes, nothing compares to how challenging, even devastating, life can be for them. It’s a reminder and a reason why we work diligently to stay connected to them and dedicated to their care.”
Dr. Monson agrees. “Our unique capabilities and specialized skill sets allow us to tackle patients and challenges that others cannot or will not do,” he says. “These patients may be the most difficult, but they are also the most satisfied.”
Looking to the future, the Intestinal Failure Treatment Team will continue to grow the program and expand its reach for the benefit of patients by assembling the best physicians and resources and conducting research into the most effective treatment protocols. We want to continue to strengthen this program.
additional background
Dr. John Monson is the executive medical director of colorectal surgery at AdventHealth. He is a fellow of the American College of Colon and Rectal Surgeons and served on its executive committee. He also serves on the Committee on Cancer (CoC), where he is Vice-Chair of the Research Committee and Vice-Chair of the OSTRiCh Consortium on Rectal Cancer Treatment.
Dr. Monson is fellowship trained in colon and rectal surgery, oncology surgery, and vascular surgery. Prior to joining AdventHealth, he led the development of laparoscopic colorectal surgery in the UK and was a former chair of the UK National Training Program, developing national standards and qualitative assessment of decision-making in cancer treatment. worked extensively on.
AdventHealth is recognized by U.S. News & World Report as one of America’s best hospitals for gastroenterology and gastrointestinal surgery. We are also recognized by The Leapfrog Group as one of America’s highest rated hospitals for patient safety.