Medical Solutions Found Where a Medical Career Began

Sharing Mayo Clinic

Medical Solutions Found Where a Medical Career Began

By
Joel Streed

April 20, 2020

For Cori Kirkpatrick, going back to the place where her husband received his medical training brought with it a well of emotions — excitement, nostalgia, anxiety. Mayo Clinic had always represented possibility and hope for her, but those sentiments took on more meaning when Cori returned to Mayo searching for a solution to her own illness.

Corinne "Cori" Kirkpatrick remembers well the initial impressions Mayo Clinic left on her when she first arrived in Rochester, Minnesota, as the 25-year-old wife of a resident physician.

"The marble, glass and steel structure rising out of the cornfields was such an impressive facility," Cori says. "You just knew you were going to be well-cared for."

The three years in the mid-1970s that Cori and her husband, John, lived in Rochester were busy ones. Cori's life revolved around having and raising their children. John's days, and sometimes nights, were spent learning to care for patients in the collaborative, patient-centric care model established by the Mayo brothers a century earlier.

"This meant collegial, empathetic medical teamwork that put the patient's needs first and that never, ever gave up on an elusive diagnosis," Cori says.

Forty-five years have passed since Cori and John lived in Rochester. Following John's internal medicine residency at Mayo Clinic, the couple moved back to their hometown of Seattle. But the familiar aura of compassion and commitment was immediately apparent to Cori when she returned in January 2019 seeking her own elusive diagnosis.

"Your doctors were just going to keep after this until they figured out what was wrong with you and figured out what they could do about it," Cori says. "That sense was still there."

For Cori, those values of dedication and understanding shone through in the comprehensive testing and collaboration that ultimately yielded a name — giant cell arteritis — for the painful and debilitating inflammatory condition of the blood vessels that had been wreaking havoc on her life.

"To have a place like this to turn to when you're really sick and no one knows what's wrong, it's really something," Cori says. "I feel so grateful that I've been able to access care like this."

Alarming, rapid deterioration

The decades since she left Rochester were largely healthy ones for Cori. In spring 2018, however, Cori experienced an odd type of pain. Even slight exertion, such as walking, caused her calves to ache and her feet to go numb. But it usually subsided if she continued walking. The problem, Cori later learned, was called clau d ication — pain caused by too little blood flow to muscles during exercise.

Cori mentioned the symptom to her physician during a routine checkup in Seattle. At the appointment, her doctor recommended an ankle-brachial index. During the test, which is performed while the patient lies down, Cori's blood pressure was found to be extremely high. That led to an appointment with a kidney specialist, who recommended magnetic resonance angiography, or MRA — a test that uses a magnetic field, radio waves and a computer to evaluate blood vessels.

The images revealed that a number of Cori's arteries — the blood vessels that take oxygen from the heart to the rest of the body — were narrowed, impeding her circulation. Arteries to her kidney and bowel, as well as femoral arteries, were all affected.

"I was down to 113 (pounds), and I could not gain it back. It was awful. I felt just horrible."
Cori Kirkpatrick

The resulting diagnosis, atherosclerosis, couldn't have come at a worse time. Cori and John were about to embark on a European vacation with 16 members of their family to celebrate their 70th birthdays. "Everyone was hesitant. Should they send me (on the trip)? Should we do a surgery?" Cori says. "They ended up putting me on a statin drug, so I wouldn't develop further atherosclerosis, and on a blood thinner, and we went on the trip."

Cori made it through the trip with only slight changes to their itinerary. But upon her return, she became fatigued and lost her appetite. "Over the last year, I'd lost 10 pounds," Cori says. "I'm not quite 5'8" and weigh between 120 and 125. I was down to 113, and I could not gain it back. It was awful. I felt just horrible."

Cori stopped wanting to see friends, and she abandoned most of her usual activities. "All I wanted to do was read," she says. "I didn't feel like myself, and it wasn't normal for me."

During this time, John had been in communication with friends and medical colleagues who asked if they'd considered seeking a second opinion. The conversations ignited a spark that led John to reach out to an old Mayo Clinic colleague, who referred Cori to Mayo Clinic's Vascular Center. There she was seen by vascular specialist Ana Casanegra, M.D. and rheumatologist Kenneth Warrington, M.D.

Collaborative, comprehensive approach

When Cori and John arrived at Mayo Clinic in Rochester in January 2019 for a week of evaluation and consultation, a lifetime of experiences had changed them, but much about Mayo Clinic and Minnesota remained constant.

"We'd forgotten about Minnesota. That everybody there was so nice and helpful and sensitive and concerned, so that was really pleasant," Cori says. "The other thing that was fun to see again was the convergence of the people at Mayo. You stand in that lobby area by the grand piano, and you see every walk of life — and I think that makes it a really special place. You really feel like they're caring for the world there."

The spirit of collaboration among physicians also was unchanged by the passage of time. During the first week Cori spent at Mayo, a team of physicians, including vascular medicine specialists, rheumatologists, nephrologists and interventional radiologists, evaluated her.

That team approach was critical to identifying Cori's hard-to-diagnose illness. "She came to the Vascular Center, which is basically a clinic that takes care of blood vessel problems," Dr. Warrington says. "Within the Vascular Center is embedded a multispecialty Vasculitis Clinic."

"Collaboration and communication are our everyday practice."
Ana Casanegra, M.D.

Vasculitis was not immediately suspected when Cori arrived at the Vascular Center, Dr. Casanegra says. But a slate of tests, including blood tests, CT scans and M R Is, and an interdisciplinary review of the results, honed in on the illness. When a form of vasculitis was identified as the source of Cori's symptoms, Dr. Warrington, an expert in vasculitis and inflammatory conditions, was brought onto the team.

"We are very fortunate to have a Vasculitis Clinic in the Vascular Center," Dr. Casanegra says. "It makes a difference to work on an interdisciplinary team that can cover all the needs of patients with any type of vascular diseases. Collaboration and communication are our everyday practice."

In addition to the collaboration, blood work and advanced imaging technologies aided in Cori's diagnosis, "She had complex imaging tailored to evaluating patients with vasculitis," Dr. Warrington explains. "So the availability of that advanced imaging at Mayo Clinic is what allowed for a better diagnosis."

After the week of evaluation, Cori and John flew home to Seattle but still lacked a name for Cori's condition. A week later, she returned for additional testing. The second set of tests included another MRA. This one focused on the thoracic aorta, which is the primary blood vessel carrying blood from the heart to the rest of the body. The test revealed the wall of the thoracic artery was thickened and inflamed, but it did not contain any fatty deposits.

"That was the definitive test," Cori says. "They knew by seeing that. They knew something else was going on."

Unusual symptoms

The condition affecting Cori was giant cell arteritis. A form of vasculitis, giant cell arteritis is an autoimmune disorder that causes changes to the blood vessels that eventually can lead to organ damage.

"The moment when Dr. Casanegra said, 'We've figured it out,' I was so excited and grateful."
Cori Kirkpatrick

"Most patients present with cranial symptoms, such as headache and jaw pain with chewing," Dr. Warrington says. "Some people may lose vision or go blind, and that is why it's so serious. Ms. Kirkpatrick didn't have those symptoms. Her vascular problems were in the aorta and lower extremities. It was an atypical presentation which likely led to the delay in diagnosis."

Although Cori had never heard of giant cell arteritis, learning the name of the condition was a transformative moment. "The moment when Dr. Casanegra said, 'We've figured it out,' I was so excited and grateful," she says.

Cori learned that the condition frequently occurs in people who've also been diagnosed with polymyalgia rheumatica, or PMR. "I had no idea that one-third of the people who have PMR go on to develop giant cell arteritis. I had PMR in my 50s, and 15 years later developed giant cell arteritis."

Life-changing treatment

Treatment for giant cell arteritis has historically been glucocorticoid (steroid) therapy. To jump-start Cori's recovery, she immediately began taking daily doses of prednisone.

"Since the 1940s, prednisone was recognized as being very effective at alleviating patients' symptoms and at preventing blindness from the disease," Dr. Warrington says. "The main concern with prednisone is that it has a long list of possible side effects. So for the last 70 years, researchers have been looking for a suitable alternative."

In 2017, the first steroid-sparing agent for the disease that was approved by the Food and Drug Administration became available. "The medicine has a similar effect on the immune system as what we're trying to achieve with prednisone without as many side effects," Dr. Warrington says.

Cori started on that drug in May 2019. Delivered via an injection under the skin or as an infusion, the medicine doesn't offer a cure, but it reduces inflammation to the point where, eventually, a patient may be able to stop taking it.

Since beginning treatment, Cori's pain has decreased substantially. "It's not like it was before all of this started, but I feel so much better," she says.

Getting her health back has increased Cori's appreciation of life's little details. "I've had a really wonderful life, and I could not ask for more," she says. "I've got three great kids and eight wonderful grandchildren, and John and I have had a wonderful marriage. So as I was circling the drain I thought, 'If this is how my life is going to end, it's OK because I've been so lucky.' But then when you find out this (condition) is treatable, and you've got a lot of good days ahead, you really start appreciating just reading the Sunday paper together and lingering over coffee."

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