Gary Owen

When Gary Owen and his wife, Joanne, walked through the doors of the Emergency Department at Saint Marys Hospital on Nov. 3, 2004, they were surprised to hear the familiar voice of Lilli Weivoda. Greeting Gary and Joanne when they arrived was a normal part of Weivoda's work as coordinator of Mayo Clinic Preferred Response Program. For the Owens, it was the first sign that Mayo Clinic was going to be a completely new experience.

For a month, Gary had been suffering from unrelenting headaches that began during a vacation in Europe. Before their trip to Saint Marys, a Mayo Clinic hospital in Rochester, Minn., Gary and Joanne had been to three other hospitals and had come away with few answers and no relief for his pain.

"When we called Mayo Clinic and talked to Lilli, she told us to come right away," says Joanne."We gathered our records and flew to Rochester. When we got there, she met us at the door. I was absolutely flabbergasted."

Gary and Joanne's medical odyssey had taken them from Italy to Monaco and back to their hometown of Reno, Nev., in search of help for Gary's debilitating headaches. But it was the experts at Mayo Clinic who finally were able to accurately identify and treat his puzzling condition.

"All of a sudden, it was a brand new world of medicine when we got to Mayo," says Gary. "After a taste of Italian and French hospitals, then not getting answers from our local doctors, Mayo Clinic was amazing."

A troubling pain

When Gary and Joanne's plane touched down in Florence, Italy, on Oct. 3, they were looking forward to touring the country, then celebrating their 40th wedding anniversary on a cruise. Those plans quickly faded as Gary's head began to ache.

At first, he thought he might have a sinus infection. He skipped the sightseeing, took some medication and tried to sleep it off. When the pain increased and spread throughout his head and back and into his chest and abdomen, Joanne called in the hotel doctor. He sent Gary to a local hospital.

"It felt like the top of my head was going to blow off," says Gary. "The pain was excruciating. I was having a hard time walking, too. My back had frozen up."

Doctors at the hospital in Florence, ran several tests, but were unable to pinpoint the problem. They gave Gary painkillers and discharged him after two days. With his headache abating somewhat, the Owens decided to continue their vacation. They boarded a cruise ship and set sail on the Mediterranean Sea.

Once aboard, however, Gary's headaches grew more severe. "All I could do was sit in our room, eat pain pills and try to use some sleeping pills, which didn't work because the pain was so terrible," he says.

In light of his deteriorating condition, the Owens decided to call for outside help. In hopes of either finding a qualified specialist close by or making arrangements to go home, they called their Marquis Jet owner services team. Their Marquis Jet representative contacted Mayo Clinic.

A client of Mayo Clinic Preferred Response — an emergency medical support program for travelers — Marquis Jet reached one of Preferred Response's call coordinators, Mary Borst. She was able to locate a hospital in Monaco where the physicians might be able to help. The Owens' ship was docked in Monte Carlo when they received the information, and they left the ship and had Gary admitted to the hospital.

David Claypool, M.D.

"We always tell our clients not to hesitate to call if they feel we can help," says Weivoda, who would become the Owens' key contact at Mayo. "Working with a patient on a cruise ship in the middle of the Mediterranean was a new one for us," says David Claypool, M.D., medical director of Mayo Clinic Preferred Response."But we have a system and resources to respond whatever the circumstances may be."

The physicians at the hospital in Monaco began to evaluate Gary's condition. "At that point, no one had a clue what was the matter," says Joanne. "They started conducting a lot of tests. They were able to determine there had been some kind of bleeding in his brain, but it had stopped. They didn't know what caused it or if it would start again."

Gary and Joanne were eager to return to the United States. On Oct. 24, they took a flight from Monaco to their hometown of Reno aboard an air ambulance. After they landed, the Owens went to a local hospital emergency room. Physicians there conducted more tests. They couldn't find the source of the bleeding, either. After two days, they sent him home.

"From the time it began in Italy to the time I left the hospital in Reno, there was no relief from the headaches," says Gary. "Although, when I went home, the pain had lessened. Instead of being a 10 on the pain scale, it was a four or five. At times, with medication and rest, it went down to a two or three. But I knew we hadn't cured anything."

Several days later, when the discomfort began to build again, Joanne called their doctor's office. "They said Gary's doctor was away on vacation," Joanne says. "Their advice if the pain became too much was to take some aspirin or come back to the emergency room. That's when we decided, 'That's it. We're going to Mayo Clinic.'"

Getting to the source

Lilli Weivoda

When Joanne called Mayo Clinic's Preferred Response Program, she reached Lilli Weivoda, who helped to make arrangements. Weivoda worked with Mayo Clinic's Emergency Department to arrange a medical evaluation for Gary when he and Joanne arrived in Rochester.

Luis Haro, M.D., the Emergency Department physician who evaluated Gary, was concerned by what he saw.

"Mr. Owen was very anxious about his health, and he had reason to be," says Dr. Haro. "When we evaluated his case and saw that no one had found the source of the bleeding in his brain, and he was still having headaches, we also became concerned. In addition, he hadn't been able to function well in his daily life for almost a month. We took all that into account and admitted him to the hospital to find some answers."

Mayo physicians had Gary's Italian and French medical records translated into English. They reviewed the information from those hospitals, as well as the hospital in Reno, and began to run a series of tests. But they also took a step that no one else had. Instead of focusing solely on Gary's brain, they conducted tests on his spine, as well.

Physicians examined a magnetic resonance (MR) scan and determined that Gary likely had an arteriovenous malformation, an abnormal tangle of arteries and veins, in his spine. His physicians suspected the malformation had burst and leaked blood into the fluid around the spinal cord. That blood would have been detected around Gary's brain because the same fluid that flows around the spinal cord also flows to the brain.

George Petty, M.D.

David Piepgras, M.D.

"The malformation in the spinal cord was difficult to diagnose because Gary's symptoms seemed to point to a problem in his brain," says George Petty, M.D., the Mayo Clinic neurologist who saw Gary when he was admitted to Saint Marys Hospital. "In addition, it's a rare condition. Many physicians might not think to look for it because it's so uncommon."

Although the results from the MR scan seemed to pinpoint Gary's problem, the diagnosis was not clear-cut. Gary's physicians followed up with an angiogram — a test that shows the detail of blood vessels — in the spinal area. That test did not reveal any abnormalities. But David Piepgras, M. D., a Mayo Clinic neurosurgeon and a member of Gary's care team, had seen this type of condition before. When he reviewed all the test results, he was certain the source of the bleeding came from the spine.

"When Dr. Piepgras talked to us, he was confident enough that there was something on Gary's spinal cord to recommend surgery," says Joanne."We were confident in him and the information he gave us, so we decided to go for it."

During the surgery, Dr. Piepgras found a malformation of the blood vessels on the left side of Gary's spinal cord that had ruptured and bled. He also found, in the fluid space around the spinal cord, a blood clot that had formed at the time of hemorrhage a month earlier. Dr. Piepgras removed the malformation, along with the associated blood clot.

According to Dr. Piepgras, Gary's pain originally had come from the presence of blood in his spinal fluid when the malformation had ruptured. As that blood circulated around his brain, the pain traveled to his head. The pain continued even after the bleeding stopped because blood remained in the spinal fluid.

"What tipped me off that this was a problem in Gary's spine was his complaint that, when it began, he experienced pain not only in his head, but also in his back, chest and abdomen," says Dr. Piepgras. "We always say, 'Listen to the patient. He's telling you the diagnosis.' Before he came to us, I don't think his physicians listened to his story and put the pieces of the puzzle together."

The return to normal

On Nov. 12, just nine days after arriving at Mayo Clinic, but more than a month since their ordeal had begun, Gary and Joanne left Saint Marys Hospital.

"When I was discharged, Dr. Piepgras said I'd still have some slight headaches until all the blood was gone, but they would go away with time," says Gary. "Sure enough, when I got home, I could still feel it a little. Then, as days went by, it was less and less, and then nothing at all. I've had no problems since then."

Gary and Joanne have returned to enjoying their lives. Retired from ownership of a nationwide company that operated warehouses and coordinated transportation of retail goods throughout the United States, the Owens now relish their free time. When they are not in Reno with their children and grandchildren, they are spending time in Hawaii or relaxing at their second home in Idaho.

"We enjoy traveling so much. But I don't think I want to get on a cruise ship again soon," says Gary. "Our travel plans this year will be limited. Beginning next year, though, we want to pick it up again."

Looking back on his experience, Gary is rather amazed by what he went through. "For the most part, Joanne and I have been healthy people. I believed the bad stuff would happen to someone else," he says. "For the first week when all this began, I thought I'd wake up out of that nightmare, and I'd be sitting at the bar on the cruise ship. Obviously, that never happened."

For anyone dealing with a similarly difficult medical experience, Gary and Joanne don't hesitate to make a recommendation about where to seek care.

"Before this, we only knew Mayo Clinic by the good things other people said about it," says Gary. "To use an old cliché, the reputation truly proceeded that place. Everything we heard was true, and then some. It was the finest medical care we've ever been exposed to in our lifetime. I tell people, 'If you have a problem you don't think your local doctor can handle, get to Mayo Clinic.'"