A Shocking Discovery

Pneumonia may have saved Paul Nolin’s life. The Fairfield resident and his wife, Ann, both fell ill in February, suffering fever, chills and a horrible, hacking cough. At 4 a.m., Feb. 26, Paul was fighting to breathe.

Ann rushed him to NorthBay Medical Center’s Emergency Department, where a doctor quickly ordered a CT scan.

What they found was alarming. An aortic aneurysm measuring nearly 6 centimeters (2.36 inches) was visible, but only in the very bottom of the frame.

“And that was just the tip of the iceberg,” says Dr. Seph Naficy, a vascular and cardiothoracic surgeon, who was called in on the case. A subsequent CT scan revealed an enormous aneurysm: 8.4 centimeters (3.31 inches) in size, which typically would require immediate surgery.

The only problem was that Paul first had to get over his pneumonia. For two weeks, he lived with what felt like a ticking time bomb in his abdomen. “He was hacking his head off,” recalls Ann. “It was very stressful.”

An aneurysm occurs when the walls of a blood vessel balloon outward, creating weakness in the vessel wall. The aorta is the largest blood vessel in the body. Put the two together, and you have a recipe for potential disaster.

The aneurysm can contain lipids, calcium clots, fatty deposits and cell debris within its walls. The aneurysm itself is not the danger, it’s the weakness it creates in the vessel wall, which, if it ruptures, would prove fatal.

At 69, Paul was a good candidate for an endovascular procedure, which is far less invasive than full-blown abdominal surgery. Incisions are made at the groin, and a catheter is used to insert a stent into the weakened area of the blood vessel, lining it and protecting it. The aneurysm is simply pushed away from the flow of blood, where it is unlikely to expand or rupture.

But Paul had other medical issues, as well as narrow blood vessels, which make placing a stent a real challenge. To deal with an aneurysm of this size, Dr. Naficy would have to place a number of perfectly sized coils and stents in just the right places.

Dr. Naficy used a state-of-the-art intravascular ultrasound technology (IVUS) to get a “real time” picture of the vessels inside Paul’s abdomen. The original plan was to run the catheter through the left side, but Dr. Naficy detected some resistance, and decided to change his operative approach.

Enter the two-man team of Richard Smith and Kevin Bowman from Medtronic, a company which specializes in stents. The pair collaborated with Dr. Naficy from Day 1 on the case, right through, and during, surgery. They were in the operating room ready to build custom stents,when Dr. Naficy decided to change his approach.

“That’s not a simple thing to do,” explains Dr. Naficy. “The device configuration must be changed, and the measurements must be exact.”

Thanks to high-quality CT scans and the IVUS technology, the team was able to make the adjustments with a positive outcome.

Ann and her daughter were getting antsy in the waiting room. The procedure lasted longer than expected. “But Joanne Jacob, a nurse from surgery, kept coming out and telling us he was OK. If she hadn’t done that, I would have been crawling the walls,” Ann says with a smile.

Ann has been a member of the NorthBay Guild ever since the couple retired and moved to Fairfield in 2002. She’s served as floor chairwoman at NorthBay Medical Center, rolled pennies for fundraisers and even made numerous quilts for Guild raffles. She suddenly found herself on the other side of the courtesy cart.

“It was a little strange, but everybody was so helpful every step of the way,” she says. “They followed up on everything and really showed compassion. Even the nurses recognized me and asked how we were doing. I felt good about being there, because it felt comfortable and familiar.”

“It’s a fancy science, and constantly evolving,” says Dr. Naficy, who is board-certified in multiple cardiac, thoracic and vascular programs. He has an active interest in combining the benefits of both open and endovascular surgery and in presenting a hybrid approach in treating these diseases.

“It was really the collaboration and teamwork that made this a positive outcome,” says Dr. Naficy. “It took everyone paying attention and delivering on all levels. If the emergency department doctor hadn’t ordered the CT scan, they may not have seen the aneurysm. And when they spotted it, they alerted me right away, so we could consult and get the process started with Medtronic. The CT scans and 3D reconstruction were just amazing work by the techs here, and truly made a difference.”

Dr. Heather Braithwaite handled Mr. Nolin’s case in the Emergency Department and ordered the test, noting that CT scans are frequently used to look for pulmonary embolisms, which sometimes appear similar to pneumonia. Symptoms include painful breathing, shortness of breath and low oxygen.

“Pulmonary embolisms are an important cause of sudden death if missed,” she explains. “His abdominal aortic aneurysm was an incidental finding as part of the imaging. Lucky for him!”

On a warm Saturday in June, Paul Nolin was back on the golf links. The retired Air Force chief master sergeant played nine holes at Cypress Lakes, and just enough to remind him of the days before surgery, when he played two or three times a week.

“It’s been pretty hard on me,” he admits. “But I’m feeling much better now. My back hurts now and then, and holds me back, but I can’t wait to get back out on the course with my friends and get back to my regular 18 holes again.”

Looking back, he doesn’t remember all the details, but he does remember the solid team effort and professional attitude of the NorthBay staff, which made him feel confident about the quality of his care. “Everyone was just exceptional, from the Emergency Department to ICU, to Surgery and beyond,” says Paul. “I feel like I was in good hands.”

Using a CT Scan, NorthBay Medical Center’s Radiology Department was able to create a 3-D image, above, of the aneurysm inside Paul Nolin’s aorta. The two bulbous images on the right and left are Mr. Nolin’s kidneys. The round image in the center is the aneurysm. The image below shows how the stent placed inside the aorta was able to redirect and eliminate the flow of blood into the aneurysm.

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